Acute postpartum dyspnea: is it a simple or a complicated item?

Abstract

Background: Peripartum cardiomyopathy (PPCM), like spontaneous coronary artery dissection (SCAD), is a disease that affect healthy women and occur in the days before and after delivery. Case Presentation: We discuss the case of a 26-year-old woman, already a mother of a boy, who gave birth to two healthy twin girls by cesarean section. Two hours after delivery, the woman suddenly developed acute dyspnea and chest pain, which had angina pectoris features and was permanent. Her electrocardiogram showed sinus tachycardia at 125 beats per minute, with no specific ST segment deviation at 12 precordial (on the ECG), but also right and posterior leads. Echocardiography showed a significant reduction in left ventricular systolic performance, with an estimated LVEF (Left Ventricular Ejection Fraction) of approximately 25%-30%, and significant hypokinesis in the mid-distal part of the interventricular septum and the apex of the left ventricle. Her blood examination revealed an increase in troponin-T high sensitivity (0.245 ng/ml), with a mild parallel increase in creatine phosphokinase, as well as the MB (isoenzyme of CPK, the most specific indicator for the myocardial infarction diagnosis) form (383 and 52 IU/l, respectively). The NT-pro BNP (N-terminal pro Brain Natriuretic Peptide) was mildly increased, too, at 1280 pg/ml. The chest pain remained until the next 36 hours when it gradually disappeared, as the dyspnea, too. She was completely recovered until the 10th day of hospitalization. The patient underwent coronary computed tomography angiography, which showed 0 Agatston coronary artery calcium score units. However, in the middle of the left anterior descending (LAD) artery, after the protrusion of the second diagonal branch, an eccentric 7 mm non-calcified lesion was observed, which caused mild stenosis (1%-24%). Conclusion: PPCM and SCAD are related to young healthy women and occur in the peripartum period. However, in some cases, their clinical picture may overlap, making the diagnosis challenging.