Abstract
BackgroundPeripartum cardiomyopathy is an uncommon form of heart failure that occurs in otherwise healthy women during pregnancy or until 5 months postpartum. Here, we report a rare case where a female patient underwent cesarean section after the occurrence of preeclampsia and intrauterine fetal death, and developed peripartum cardiomyopathy following postsurgical respiratory distress. The prompt initiation of inotropic drug and bromocriptine therapy quickly restored cardiac function.Case presentationThe patient was a 36-year-old woman who underwent emergency cesarean section for a previous preeclampsia and an intrauterine fetal death that occurred after 24 weeks of pregnancy. In addition, the patient had an extremely low platelet count of 5000/μL on admission. She had been diagnosed as idiopathic thrombocytopenic purpura at the age of 29 years old and treated with prednisolone at 15 mg/day. Therefore, the cesarean section was performed under general anesthesia. The patient did not exhibit respiratory or hemodynamic dysfunction during surgery. However, she developed respiratory distress with sinus tachycardia after extubation and was transferred to the intensive care unit. A chest radiograph showed butterfly shadows, and transthoracic echocardiogram confirmed the reduction of left ventricle contractility (ejection fraction 20%). She was diagnosed with peripartum cardiomyopathy and treated immediately with intravenous milrinone, oral bromocriptine, and angiotensin-converting enzyme inhibitor. Respiratory and hemodynamic function improved rapidly, and the patient was moved to the general ward 2 days after surgery. Fourteen days after surgery, the patient had an ejection fraction of 57%. The patient recovered without any further complications and was discharged 24 days after surgery.ConclusionA sudden case of peripartum cardiomyopathy was successfully managed by a prompt diagnosis and treatment with inotropic agents and bromocriptine.
Highlights
Peripartum cardiomyopathy is an uncommon form of heart failure that occurs in otherwise healthy women during pregnancy or until 5 months postpartum
Peripartum cardiomyopathy (PPCM) refers to an uncommon form of idiopathic heart failure that occurs during pregnancy or until 5 months postpartum [1, 2]
The patient had been diagnosed as idiopathic thrombocytopenic purpura at the age of 29 years old that was being treated with oral prednisolone (15 mg/day)
Summary
Peripartum cardiomyopathy (PPCM) refers to an uncommon form of idiopathic heart failure that occurs during pregnancy or until 5 months postpartum [1, 2]. General anesthesia was induced using propofol (120 mg), rocuronium (50 mg), and fentanyl (200 μg) During operation, she was managed with her systolic blood pressure from 90 to 120 mmHg, heart rate from 100/min to 120/min, and PaO2/FiO2 ratio ≥ 300 under fraction of inspiratory oxygen of 0.40. After the completion of the surgery, the trachea of the patient without intraoperative excessive tachycardia, low blood pressure, low oxygenation, and pink frothy sputum was extubated in the operating room She gradually developed respiratory distress with sinus tachycardia (120–140/ min) and slightly high systolic blood pressure (140–150 mmHg) right after extubation. On the second postoperative day, the patient was moved to the general ward with a blood pressure of 140/80 mmHg, an SpO2 of 97% (supplemental oxygen at 2 L/min), and an EF of 40%. The patient recovered without any further complications and was discharged 24 days after surgery
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