A tale of the broken heart: peripartum cardiomyopathy, a case report

  • Hori Hariyanto Department of Anesthesiology and Critical Care Medicine, Siloam Hospitals Lippo Village, Tangerang
  • Corry Q. Yahya Department of Anesthesiology, Faculty of Medicine, Universitas Pelita Harapan, Tangerang
  • Primartanto Wibowo Department of Anesthesiology and Critical Care Medicine, Siloam Hospitals Lippo Village, Tangerang
  • Oloan E. Tampubolon Department of Anesthesiology and Critical Care Medicine, Siloam Hospitals Lippo Village, Tangerang
Keywords: acute heart failure, management, peripartum
Abstract viewed: 1858 times
PDF downloaded: 1042 times
HTML downloaded: 199 times
EPUB downloaded: 84 times

Abstract

Progressive dyspnea following childbirth warrants a prompt suspicion into the diagnosis of peripartum cardiomyopathy, PPCM. Pump failure causes an inadequate cardiac output which ultimately contributes to PPCM high mortality rate; however early airway control, vigilant fluid balance and vasoactive support will substantially reduce the incidence of patients falling into decompensated heart failure. More importantly, it is imperative that these patients are cared in a setting where continuous hemodynamic monitoring is available. This case report serves as a reminder not to focus end-point therapy solely on blood pressure readings, but to observe signs and symptoms of hypoperfusion such as cold clammy skin, cool extremities, decreased urine output and mental status.

Author Biographies

Hori Hariyanto, Department of Anesthesiology and Critical Care Medicine, Siloam Hospitals Lippo Village, Tangerang
Department of Anesthesiology and Critical Care Medicine
Corry Q. Yahya, Department of Anesthesiology, Faculty of Medicine, Universitas Pelita Harapan, Tangerang

Universitas Pelita Harapan

Primartanto Wibowo, Department of Anesthesiology and Critical Care Medicine, Siloam Hospitals Lippo Village, Tangerang
Department of Anesthesiology and Critical Care Medicine
Oloan E. Tampubolon, Department of Anesthesiology and Critical Care Medicine, Siloam Hospitals Lippo Village, Tangerang
Department of Anesthesiology and Critical Care Medicine

References

  1. Sliwa K, Fett J, Elkayam U. Peripartum cardiomyopathy. Lancet. 2006;368(9536):687–93. http://dx.doi.org/10.1016/S0140-6736(06)69253-2

  2. Brar SS, Khan SS, Sandhu GK, Jorgensen MB, Parikh N, Hsu JW, et al. Incidence, mortality, and racial differences in peripartum cardiomyopathy. Am J Cardiol. 2007;100(2):302–4. http://dx.doi.org/10.1016/j.amjcard.2007.02.092

  3. Pearson GD, Veille JC, Rahimtoola S, Hsia J, Oakley CM, Hosenpud JD, et al. Peripartum cardiomyopathy: national heart, lung, and blood institute and office of rare diseases (National Institutes of Health) workshop recommendations and review. JAMA. 2000;283(9):1183–8. http://dx.doi.org/10.1001/jama.283.9.1183

  4. Conrad KP, Karumanchi SA Renal physiology and diseases in pregnancy. 5th ed. In: Alpern RJ, Caplan MJ, Moe OW, editors. Seldin and Giebisch's The Kidney: Physiology and Pathophysiology. United Kingdom: Elsevier; 2013. p. 2701–17. http://dx.doi.org/10.1016/B978-0-12-381462-3.00081-1

  5. Hibbard JU, Lindheimer M, Lang RM. A modified definition for peripartum cardiomyopathy and prognosis based on echocardiography. Obstet Gynecol. 1999;94(2):311–6. http://dx.doi.org/10.1097/00006250-199908000-00030

  6. Wiener-Kronish JP, Broaddus VC. Interrelationship of pleural and pulmonary interstitial liquid. Annu Rev Physiol. 1993;55:209–26. http://dx.doi.org/10.1146/annurev.ph.55.030193.001233

  7. Wiesen J, Ornstein M, Tonelli AR, Menon V, Ashton RW. State of evidence: mechanical ventilation with PEEP in patients with cardiogenic shock. Heart. 2013;99(24):1812–7. http://dx.doi.org/10.1136/heartjnl-2013-303642

  8. Harvey PA, Leinwand LA. Celular mechanisms of cardiomyopathy. J Cell Biol Dis. 2011;194(3):355–65. http://dx.doi.org/10.1083/jcb.201101100

  9. Zhang YH, Youm JB, Sung HK, Lee SH, Ryu SY, Lee SH, et al. Stretch-activated and background non-selective cation channels in rat atrial myocytes. J Physiol. 2000;523(Pt3):607–19. http://dx.doi.org/10.1111/j.1469-7793.2000.00607.x

  10. Yancy CW, Jessup M, Butler J, Drazner MH, Geraci SA, Januzzi JL, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundataion/American Heart Association task force on practice guidelines. Circulation. 2013;128:e240–327. http://dx.doi.org/10.1161/CIR.0b013e31829e8807

  11. Elkayam U, Tummala PP, Rao K, Akhter MW, Karaalp IS, Wani OR, et al. Maternal and fetal outcomes of subsequent pregnancies in women with peripartum cardiomyopathy. N Engl J Med. 2001;344(21):1567–71. http://dx.doi.org/10.1056/NEJM200105243442101

  12. Elkayam U, Akhter MW, Singh H, Khan S, Bitar F, Hameed A, et al. Pregnancy-associated cardiomyopathy: clinical characteristics and a comparison between early and late presentation. Circulation. 2005;111(16):2050–5. http://dx.doi.org/10.1161/01.CIR.0000162478.36652.7E

Published
2016-04-15
How to Cite
1.
Hariyanto H, Yahya CQ, Wibowo P, Tampubolon OE. A tale of the broken heart: peripartum cardiomyopathy, a case report. Med J Indones [Internet]. 2016Apr.15 [cited 2024Apr.18];25(1):57-1. Available from: http://mji.ui.ac.id/journal/index.php/mji/article/view/1278
Section
Case Report/Series