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Abstract
Introduction: Peripartum cardiomyopathy (PPCM) is a disease characterized by an enlargement of the heart muscle wall. The disease occurs in the last month of pregnancy up to 5 months postpartum, with no previous history of heart disease. The etiology of the disease is unclear. Early recognition of this case can lead to decrease in morbidiy and mortality.
Case: A 20-year-old woman came to the Emergency Unit with a shortness of breath. There is a history of give birth about 4 months ago. Physical examination shows a regular heart rhythm accompanied by rhonchi sound in the basal aspect of lung. In the M-mode analysis of ECG showed left ventricular systolic ejection function is decrease (56.5%) while the right ventricle is normal. In the Hospital, patient get treated with diuretics, aldosterone antagonist, angiotensin II receptor blocker and fluid management. Patient gave good responsed to the therapy regiment.
Discussion: The early clinical manifestations of PPCM are difficult to recognize. In the majority of patients, 78% of symptoms are found at 4 months after delivery, only 9% of patients show symptoms in the last month of pregnancy. Clinical symptoms include atypical chest pain, abdominal discomfort, signs of pulmonary edema, orthopnea and paroxysmal nocturnal dyspnea. In the management of patients with PPCM is almost similar to management in other congestive heart disease.
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References
- Hardaway B., Tang W.H.W. Heart Failure With Systolic Dysfunction. in Griffi n B.P., Topol E.J., Nair D., Ashley K., editor, 2009. Manual of Cardiovascular Medicine Third Edition. USA: Lippincott Williams & Wilkins,; 105 – 122.
- Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, Regitz-Zagrosek V, et al. 2012, Position statement on current state of kowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on Peripartum Cardiomyopathy. European J. Heart Failure;12:767-78. doi: 10.1093/eurjhf/hfq120
- Van Spaendonck-Zwarts KY, van Tintelen JP, van Veldhuisen DJ, van der Werf R, Jongbloed JD, Paulus WJet al. 2010, Peripartum cardiomyopathy as a part of familial dilated cardiomyopathy. Circulation;121:2169-75. doi: 10.1161/CIRCULATIONAHA.109.929646
- Gentry M.B., Dias J.K., Luis A., Patel R., Thornton J., Reed G.L. 2010.African American Women Have a Higher Risk for Developing Peripartum Cardiomyopathy. Journal of th American College of Cardiology;55:654-659. doi: 10.1016/j.jacc.2009.09.043
- Mann, D.L. Patophysiology of Heart Failure. Dalam. Libby P., Bonow R.O., Mann D.L., Zipes D.P., editor. 2007, Braunwald’s Heart Disease : a Textbook of Cardiovascular Medicine, 8th edition. USA : Elseviers Saunders,; Hal 541 – 560.
- Ashley K.E. Heart Diseases in Women. Dalam. Griffi n B.P., Topol E.J., Nair D., Ashley K., editor. 2009, Manual of Cardiovascular Medicine Third Edition. USA : Lippincott Williams & Wilkins,; Hal 553 – 563.
- Johnson-Coyle L, Jensen L, Sobey A, 2012, American Heart Association, Peripartum cardiomyopathy: review and practice guidelines. Am J Crit Care 21(2): 89-98, doi: 10.4037/ajcc2012163
- Wein M.N., Dec G.W., Lilly L.S. The Cardiomyopathies. Dalam. Lilly L.S., editor. Pathophysiology of Heart Diseases : A Collaborative Project of Medical Students and Faculty, Fourth Edition. USA : Lippincott Williams & Wilkins, 2007; Hal 252 – 268.
- Okeke TC, Ezenyeaku CCT, Ikekako LC, 2011. Peripartum cardiomyopathy. Ann. Med. He Ramachandran R, Rewari V, Trikha A. Anaesthetic management of patients with peripartum cardiomyopahty. J. Obstetr. Anaesth. Crit. Care; 3(3): 313–319. doi: 10.4103/2141-9248.117925
- Ramachandran R, Rewari V, Trikha A. 2011, Anaesthetic management of patients with peripartum cardiomyopahty. J. Obstetr. Anaesth. Crit. Care;1(1):5-12. DOI: 10.4103/2249-4472.84249
- Dickstein K, Cahen-solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. Eur J Heart Fail. 2008; 10: 933–89.
- Modi KA, Illum S, Jariatul K, Caldito G, Redday PC. Poor outcome of indigent patients with peripartum cardiomyopathy in the United States. Am J Obstet Gynecol. 2009; 201: 171.e1–5.
- Safirstein JG, Ro AS, Grandhi S, Wang L, Fett JD, Staniloae C, 2010. Predictors of left ventricular recovery in a cohort of peripartum cardiomyopathy patients recruited via the internet. Int J Cardiol.
- Kolte D, Khera S, Aronow WS, et al. Temporal trends in incidence and outcomes of peripartum cardiomyopathy in the United States: a nationwide population-based study. J Am Heart Assoc. 2014;3:e001056
References
Hardaway B., Tang W.H.W. Heart Failure With Systolic Dysfunction. in Griffi n B.P., Topol E.J., Nair D., Ashley K., editor, 2009. Manual of Cardiovascular Medicine Third Edition. USA: Lippincott Williams & Wilkins,; 105 – 122.
Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, Regitz-Zagrosek V, et al. 2012, Position statement on current state of kowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on Peripartum Cardiomyopathy. European J. Heart Failure;12:767-78. doi: 10.1093/eurjhf/hfq120
Van Spaendonck-Zwarts KY, van Tintelen JP, van Veldhuisen DJ, van der Werf R, Jongbloed JD, Paulus WJet al. 2010, Peripartum cardiomyopathy as a part of familial dilated cardiomyopathy. Circulation;121:2169-75. doi: 10.1161/CIRCULATIONAHA.109.929646
Gentry M.B., Dias J.K., Luis A., Patel R., Thornton J., Reed G.L. 2010.African American Women Have a Higher Risk for Developing Peripartum Cardiomyopathy. Journal of th American College of Cardiology;55:654-659. doi: 10.1016/j.jacc.2009.09.043
Mann, D.L. Patophysiology of Heart Failure. Dalam. Libby P., Bonow R.O., Mann D.L., Zipes D.P., editor. 2007, Braunwald’s Heart Disease : a Textbook of Cardiovascular Medicine, 8th edition. USA : Elseviers Saunders,; Hal 541 – 560.
Ashley K.E. Heart Diseases in Women. Dalam. Griffi n B.P., Topol E.J., Nair D., Ashley K., editor. 2009, Manual of Cardiovascular Medicine Third Edition. USA : Lippincott Williams & Wilkins,; Hal 553 – 563.
Johnson-Coyle L, Jensen L, Sobey A, 2012, American Heart Association, Peripartum cardiomyopathy: review and practice guidelines. Am J Crit Care 21(2): 89-98, doi: 10.4037/ajcc2012163
Wein M.N., Dec G.W., Lilly L.S. The Cardiomyopathies. Dalam. Lilly L.S., editor. Pathophysiology of Heart Diseases : A Collaborative Project of Medical Students and Faculty, Fourth Edition. USA : Lippincott Williams & Wilkins, 2007; Hal 252 – 268.
Okeke TC, Ezenyeaku CCT, Ikekako LC, 2011. Peripartum cardiomyopathy. Ann. Med. He Ramachandran R, Rewari V, Trikha A. Anaesthetic management of patients with peripartum cardiomyopahty. J. Obstetr. Anaesth. Crit. Care; 3(3): 313–319. doi: 10.4103/2141-9248.117925
Ramachandran R, Rewari V, Trikha A. 2011, Anaesthetic management of patients with peripartum cardiomyopahty. J. Obstetr. Anaesth. Crit. Care;1(1):5-12. DOI: 10.4103/2249-4472.84249
Dickstein K, Cahen-solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. Eur J Heart Fail. 2008; 10: 933–89.
Modi KA, Illum S, Jariatul K, Caldito G, Redday PC. Poor outcome of indigent patients with peripartum cardiomyopathy in the United States. Am J Obstet Gynecol. 2009; 201: 171.e1–5.
Safirstein JG, Ro AS, Grandhi S, Wang L, Fett JD, Staniloae C, 2010. Predictors of left ventricular recovery in a cohort of peripartum cardiomyopathy patients recruited via the internet. Int J Cardiol.
Kolte D, Khera S, Aronow WS, et al. Temporal trends in incidence and outcomes of peripartum cardiomyopathy in the United States: a nationwide population-based study. J Am Heart Assoc. 2014;3:e001056