Challenges in management of peripartum cardiomyopathy with diuretic resistance, hypoalbuminemia and hypothyroidism

Abstract

Background: Peri-partum cardiomyopathy is an idiopathic cardiomyopathy that presents with heart failure secondary to left ventricle systolic dysfunction towards the end of pregnancy or in the months after delivery, in the absence of any other cause of heart failure.Approximately 75% of cases are diagnosed within the first month peri-partum, and 45% present in the first week. Case presentation: In this report we present a 30 years old female patient, Para 1 living 1, who was admitted one month ago with complaints of abdominal distension, lower limb swelling and difficulty in breathing that started worsening two weeks prior.12-lead ECG showed sinus tachycardia (100beats/min), low voltage and non-specific T inversion and flattening.Echocardiography showed dilated left ventricle (5.8cm) and left atrium (4.4cm), global hypokinesia with ejection fraction of 36% by biplane. Grade 1 diastolic dysfunction, no thrombus seenand Mild pericardial effusion. Conclusion: Peripartum cardiomyopathy is a form of dilated cardiomyopathy associated with considerable morbidity and mortality,thus it should not be underestimated. It should be dealt with accordingly and when suspected, one must establish the diagnosis rapidly.