Management of Peripartum Cardiomyopathy with Secondary Large Left Ventricular Apical Clot using Novel Oral Anticoagulants: A Case Report

Abstract

Peripartum Cardiomyopathy (PPCM) is a major life-threatening complication of pregnancy, as only half of them or slightly more patients show improvement of Left Ventricular (LV) dysfunction. A 28-year-old woman with a history of gestational hypertension and diabetes during pregnancy, underwent full-term normal vaginal delivery. She started developing dyspnea, Class II which progressed to Class IV postpartum. Kidney and liver functions were found to be grossly deranged along with thrombocytopenia. Provisional diagnosis of Haemolysis, Elevated Liver Enzymes and Low Platelets (HELLP) was made. Electrocardiography (ECG) revealed the left anterior fascicular block. Eventually, bedside echocardiogram revealed severe LV dysfunction and the presence of a large soft LV apical clot with an Ejection Fraction (EF) of 30%. Adequate anticoagulation was achieved using Novel Oral Anticoagulants (NOAC). After six days and a 3-month follow-up, an echocardiogram demonstrated a significant improvement of LV function (EF-45%) and a complete resolution of LV apical clot, respectively.