141 Eclampsia as the first presentation of peripartum cardiomyopathy

Abstract

Introduction In some cases eclampsia (which is the main cause of mortality during pregnancy) may be associated with peripartum cardiomyopathy (the main cause of serious complications during pregnancy and postpartum period). Case report Female patient 36 years old, in the 30th week of gestational (the first pregnancy), previously completely healthy, was admitted to hospital due to syncope, convulsion and hypertension (160/100 mmHg). The caesarean delivery was performed immidiately. ECG and echocardiography were without pathological findings, but because of elevated troponin I (0,19) and NT pro BNP (1500), CT coronary angiography was performed. The finding on coronary arteries was completely normal. After improvement in clinical symptoms, values of blood pressure and laboratory findings, patient was discharged. Three months later (in the meantime she didn’t come on the routine clinical folow-up) she was again admitted to hospital due to dyspnoea, peripheral edema and palpitations. Symptoms had begun ten days before that. Physical examination indicated systolic murmur at the apex, signs of left and right heart failure. Laboratory analysis showed leukocytosis, anemia, increased liver ensymes AST (62), LDH (531), uric acid (548), CRP (7,5) and significant increase of NT pro BNP (20975). Electrocardiogram pointed to tachycardia and T-wave inversion in standard and precordial leads. Chest X-ray demonstrated enlarged heart shadow without pathological changes in the lungs. The patient underwent an echocardiography exam which showed dilated left ventricle, global hypokinetic, with low ejection fraction (25%) and with large thrombus in the apex, with very high embolic potential. It also demonstrated moderate mitral regurgitation. The patient was treated according to guidelines on acute and chronic heart failure with ACE inhibitors, beta blockers, diuretics, mineralocorticoid receptor antagonists, also with anticoagulant therapy and supstitution therapy of folic acid and iron, with addition of bromocriptine. Two months later she was symptomless, while echocardiography showed improvement in ejection fraction (45–50%), reduction of mitral regurgitation and completely resolution of the left ventricle thrombus. Finally, about twelve months later, coming to a complete clinical, laboratory, ECG and echocardiography restitution. Conclusion In case of presentation of eclampsia it is necessary to follow up the patient frequently not to miss the beginning of sytolic disfunction due to peripartum cardiomyopathy, which may be coused by eclampsia. It is also important to be aware that some cases need more time (not only six months) for complete restitution.