Page 8 - Demo

MOGS Chronicles | Volume 1 | Issue 1 | September 2024 1IntroductionPeripartum cardiomyopathy (PPCM) is a rare but severe form of dilated cardiomyopathy occurring towards the end of pregnancy or in early postpartum period characterized by systolic heart failure and reduced left ventricular ejection fraction (LVEF). Figure 1 shows the pathology in dilated cardiomyopathy. Despite its recognition for over a century, PPCM%u2019s etiology remains largely unclear, making timely diagnosis and management challenging.[1]Case Presentation26-year primigravida presented to the emergencydepartment on the first postpartum day with complaints ofsignificant breathlessness and bilateral lower limb edema.Pregnancy was uneventful until the 26th week, when shewas diagnosed with pregnancy-induced hypertension andprescribed labetalol 100 mg twice daily. By 27 weeks,she developed bilateral lower limb edema. At 28 weeks,patient developed antepartum haemorrhage, leading tohospitalization. A preterm vaginal delivery was performed,resulting in the birth of a live male baby weighing 890 gand was transferred to neonatal intensive care unit (ICU).On postpartum day 1, patient presented with severe dyspnea and difficulty in breathing. Examination revealed tachycardia (heart rate 136/min), hypertension (blood pressure 160/110 mmHg), and significant hypoxemia (SpO2 80% on room air). Physical examination showedbilateral crackles on respiratory auscultation, a soft abdomen, and a well-contracted uterus.A 2D echocardiogram [Figure 2] demonstrated global left ventricular hypokinesia with an ejection fraction (LVEF) of 15%u201320%, moderate mitral regurgitation, inferior vena cava was 14 mm non-collapsing. Arterial blood gases indicated respiratory and metabolic acidosis.Given the severity of the presentation and the echocardiographic findings, a provisional diagnosis of PPCM with antepartum hemorrhage was made. To assess organ congestion, a venous excess ultrasound score was used, highlighting significant congestion.Patient was admitted to ICU. A multidisciplinary approach was employed, involving intensivists, cardiologists, and obstetricians. Management plan included mechanical ventilation initiated due to persistent tachypnea and increased work of breathing. Nitroglycerin support started for vasodilation.Renal support with Lasix infusion for diuresis, patient required two sessions of sustained low-efficiency dialysis due to acute kidney injury and for decongestion. Inotropic support with Noradrenaline and dobutamine infusions to support cardiac function was given.[2] Invasive monitoring with central venous catheter and arterial line insertion was done.By the end of day 2, the patient showed improvement, she remained on ventilator support but was hemodynamically stable. Sedation was reduced, inotropic support was tapered, and arterial blood gases improved with no obvious acidosis.On day 3, the patient was extubated, maintained saturation Case ReportAbstractPeripartum cardiomyopathy is a rare condition that manifests as heart failure during the last month of pregnancy or within 5 months after delivery. This case report describes a 32-year-old woman who presented with symptoms of severe fatigue, dyspnea, and edema 2 months postpartum. Initial evaluations suggested a common postpartum recovery; however, further diagnostic work revealed significantly reduced left ventricular ejection fraction (LVEF) and cardiomegaly. A multidisciplinary approach was employed, including cardiology and obstetrics, leading to the initiation of appropriate heart failure management, including diuretics and beta-blockers. The patient showed improvement in symptoms and LVEF over 6 months and achieved a full recovery ultimately.Keywords: Peripartum cardiomyopathy, Dilated cardiomyopathy, Systolic heart failurePeripartum Cardiomyopathy %u2013 A ConundrumGandhali Deorukhkar, Nikita AgrawalDepartment of Maternity and Child Care, Wockhardt Hospital, Mumbai, Maharashtra, IndiaAddress for correspondence: Nikita Agarwal, Wockhardt Hospital, Mumbai, Maharashtra, India. Phone: 9403636366. E-mail: nikitaagrawal2703@gmail.comFigure 1: Normal heart and dilated cardiomyopathy