Emergency management of term pregnant female with decompensated peripartum cardiomyopathy

Abstract

Introduction Peripartum cardiomyopathy (PPCM) is a rare life-threatening cardiomyopathy of unknown cause that occurs in the peripartum period in previously healthy women. The diagnosis of PPCM rests on the echocardiographic identification of new left ventricular systolic dysfunction during a limited period surrounding parturition. This entity presents a diagnostic challenge because many women in the last month of a normal pregnancy experience dyspnoea, fatigue, and pedal oedema, symptoms identical to early congestive heart failure. Therefore, it is important that a high index of suspicion be maintained to identify the rare case of PPCM as general examination showing symptoms of heart failure with pulmonary oedema. PPCM remains a diagnosis of exclusion. Discussion An interesting case of 37-year-old female (primigravida) G1P0L0 presented at 37weeks gestation with chief complaint of progressively increasing breathlessness for 15days and swelling in both lower limbs for 7days presented in ED. Her general condition – poor, blood pressure – 180⧹110mmHg, pulse – 136⧹ min irregular, RR 36⧹min, Pallor ++, JVP raised, pedal oedema + cardiovascular exam showed S3 gallop rhythm, P2 loud (pulmonary hypertension) and chest with bilateral crepitation's (pulmonary oedema). She was managing on the line of preeclampsia toxaemia elsewhere. We diagnose her having CHF due to PPCM that was managed only with timely diagnosis and prompt management and save two lives with help of multidisciplinary team. Lesson from successful case management will help others to differentiate physiological changes during pregnancy with other life threatening disease that can be with or during pregnancy. The detailed management and discussion will be presented at time of presentation.