Acute Decompensated Heart Failure Following Cesarean Delivery: A Case of Undiagnosed Rheumatic Heart Disease [14B

Abstract

INTRODUCTION: Heart failure is a leading cause of maternal morbidity and mortality in the United States. It commonly occurs in the peripartum period—the last trimester and five months following delivery. It stems from multiple etiologies, most commonly peripartum cardiomyopathy and preexisting cardiac disease. The diagnosis of heart failure in the peripartum period is often delayed or misdiagnosed because its symptoms closely resemble those seen during normal pregnancy, pulmonary embolism, preeclampsia, and HELLP syndrome - including fatigue, shortness of breath and edema. METHODS: A 25-year-old G2P2 Burmese patient with no prior medical history presented five-days post cesarean delivery with chief complaint of shortness of breath, chest pressure, and palpitations. She was found to have tachypnea, tachycardia to the 140's, and hypoxemia with an oxygen saturation of 85%. Her EKG demonstrated atrial fibrillation with rapid ventricular response. Echocardiogram revealed findings consistent with undiagnosed Rheumatic Heart Disease (RHD) including bi-atrial enlargement, moderate mitral valve regurgitation, moderate tricuspid valve regurgitation, severe aortic valve regurgitation, moderate pulmonic valve regurgitation, and an LVEF of 55-60%. CONCLUSION: Diagnosis of RHD is rare in developed countries due to near eradication from improved efforts to administer antibiotic treatment. We hope our presentation sheds light on the burden of RHD that persists in developing nations and encourages providers to assess the possibility of this diagnosis in a subset of patients. Prompt diagnosis requires heightened awareness among multidisciplinary teams, a high degree of suspicion, and confirmation via echocardiographic studies. Treatment with targeted therapies can recover ventricular function in the majority of cases.