P413 A CASE OF PERIPARTUM DILATED CARDIOMYOPATHY WITH SEVERE BIVENTRICULAR DYSFUNCTION

Abstract

Abstract Woman, 38 aa, without cardiovascular risk factors with the exception of the tobagic habit; In anamnesis recent Caesarean cut about six months ago for a placenta with the central, complicated by hemorrhagic shock and consequent virgonecontomy. It came to our observation sent by the emergency room, where it had gone by on the onset of about 20 days of heart disease, nightlife dyspnea and fattening dyspnea, associated with the recent appearance of marked edemas declining in the lower limbs bilaterally. At the entrance to the ward, the patient presented himself vigilant, apipperic and tachipnoic. The feedback of turgor of the jugular and of extended edemas extended up to the upper third of the leg bilaterally was also reported. The ECG evidenced a sinus tachycardia and signs of left ventricular overload. The hematochimic tests, including myocardionecrosi markers, were in the norm, with the exception of the pro–bnp which was increased with a value of 5263 pg/ml (cutoff <125 pg/ml). A trastracic echocardiogram was carried out which highlighted a dilated left ventricle with normal parietal thicknesses, global hypocinesia and severely depressed systolic function (FE 28%), a biatrial dilation with dilated and hypocinetic right sections (15mm tapse), to the Doppler color, an insufficiency Mutral valve of moderate and tricuspidal grade of severe grade with an estimated paps of 55 mmhg and a lower cava dilated cava and poorly collapsed with the inspirium. For further diagnostic deepening, a cardiac MRI was performed which confirmed the framework of two–hundred dilation with severe reduction of systolic function (LVEF 25%; RVEF 20%) and showed a post–control myocardial strengthening of the lateral pericardium with extension to be paid by the Subpicardio homosede. A high dosage diuretic therapy and anti–scompense therapy with progressive improvement of the hemodynamic picture was then set. The patient was discharged at home in protected discharge after positioning of wearable defibrillator; It was then checked after 30 days from discharge with a recovery feedback almost complete with the contractile function and followed later over time with periodic follow–ups.