Peripartum dilated cardiomyopathy

Abstract

Peripartum cardiomyopathy is a rare cause of heart failure late in pregnancy or during the postpartum period, with guarded prognosis. The underlying cause remains elusive. Diagnosis is essentially by exclusion. Prognosis in peripartum cardiomyopathy continues to be guarded, with mortality still 25–50% and most deaths within the first 3 months of diagnosis. We are presenting the case of a 30 year old primigravida with Peripartum Cardiomyopathy with preeclampsia. She was induced for pre-eclampsia. She underwent caesarean section for unsuccessful trial of instrumental delivery. Subsequently she had postpartum haemorrhage and blood transfusion. Day 4 postpartum admitted as an emergency with breathlessness, palpitation and high blood pressure. Her P 105/mt, BP:170/94 mm Hg, respiratory rate was 24/mt and SaO2:91% on air. On examination, her abdomen was soft, non-tender. Examination of respiratory system revealed bilateral crepitations at lung bases. Chest X ray showed consolidation and cardiomegaly Echocardiography showed mild to moderate mitral regurgitation with reduced ejection fraction consistent with peripartum cardiomyopathy. She was commenced on intravenous antibiotics and Furosemide and was closely monitored in the ITU. CTPA excluded pulmonary embolism. In the cardiac ward, she was commenced on Ramipril and spironolactone and arranged a repeat echo and cardiac MRI. We will be including the results of this investigations Peripartum cardiomyopathy in our case may be caused by a combination of endothelial dysfunction induced by preeclampsia and increased blood volume returning to the left atrium after surgery and during the early postpartum period In postpartum patients with preeclampsia, sudden onset of breathlessness and signs and symptoms of cardiac failure should raise a high index of suspicion, and therefore should have prompt investigations, early multidisciplanry involvement and institution of appropriate treatment to reduce high mortality associated with this condition.