Abstract

Case Report

Unusual and severe peripartum cardiomyopathy: A case report

Lamanna B*, Vinciguerra M, Crupano FM, Cicinelli R, Cicinelli E and Vimercati A

Published: 05 May, 2021 | Volume 6 - Issue 2 | Pages: 040-043

Peripartum cardiomyopathy (PPCM) is a relatively rare cardiac disease that manifests in the final stage of pregnancy and in the first months after delivery in women with no preexisting heart disease. Many etiological processes have been suggested: viral myocarditis, abnormal immune response to pregnancy, excessive prolactin excretion, prolonged tocolysis and a familiar predisposition to PPCM. Its diagnosis is often delayed because its symptoms, which include fatigue, dyspnea and palpitations are nonspecific. For this reason the diagnosis of PPCM is still made by exclusion of other etiologies. The long-term prognosis, once the acute phase is over, is a function of myocardial damage, this varies from complete functional recovery to chronic HF. The outcome of PPCM is highly variable with an alevated risk of fetomaternal morbidity and mortality. We report a serious case of a 40 years old female with biamniotic bicorionic twin pregnancy (PMA) who delivered by caesarean section and developed acute PPCM on post-operative. Symptoms occurred two hours after an intramuscular injection of two vials of methylergonovine the same day of cesarean delivery. These manifested in sudden tachypnoe, tachycardia and the appearance itchy maculopapular rash on her chest. On further evaluation, ECHO revealed cardiomegaly with reduced ejection fraction (< 15%). The case was successfully managed by a multidisciplinary team, using drugs like levosimendan and cabergoline, which rapresent emerging strategy in this clinical context.

Read Full Article HTML DOI: 10.29328/journal.jccm.1001116 Cite this Article Read Full Article PDF

References

  1. Triebel J, Clapp C, de la Escalera GM, Bertsch T. Remarks on the Prolactin Hypothesis of Peripartum Cardiomyopathy. Front Endocrinol (Lausanne). 2017; 8: 77. PubMed: https://pubmed.ncbi.nlm.nih.gov/28443067/
  2. Ware JS, Li J, Mazaika E, Yasso CM, DeSouza T, Cappola TP, et al. Shared Genetic Predisposition in Peripartum and Dilated Cardiomyopathies. N Engl J Med. 2016; 374: 233-241. PubMed: https://pubmed.ncbi.nlm.nih.gov/26735901/
  3. Ankita Kumara SS. Peripartum cardiomyopathy: a review of three case reports. Jp J. 2012.
  4. Bouzerda A. Cardiomyopathie du péripartum: à propos d’une observation et revue de la littérature Peripartum cardiomyopathy: about a case and review of the literature. Pan Afr Med J. 2016; 25: 21. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5268752/
  5. Huang Y, Chen T, Zhang M, Yang X, Ding G, et al. Successful management of fatal peripartum cardiomyopathy in a young pregnant woman: A case report. Medicine (Baltimore). 2018; 97: e0408. PubMed: https://pubmed.ncbi.nlm.nih.gov/29642207/
  6. Baris L. Peripartum cardiomyopathy: disease or syndrome? Heart. 2019
  7. Ziccardi MR, Siddique MS. Peripartum Cardiomyopathy. StatPearls Publishing. 2020
  8. Demakis JG, Rahimtoola SH, Sutton GC, Meadows WR, Szanto PB, et al. Natural course of peripartum cardiomyopathy. Circulation. 1971; 44(6):1053-61. PubMed: https://pubmed.ncbi.nlm.nih.gov/4256828/
  9. Pearson GO, Veille JC, Rahimtoola S, Hsia J, Oakley CM, 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: 1183-1188. PubMed: https://pubmed.ncbi.nlm.nih.gov/10703781/
  10. Michael C Honigberg MM. Peripartum cardiomyopathy. Tratto il giorno 2020 da bmj.com: 2019. PubMed: https://www.bmj.com/content/364/bmj.k5287.long
  11. Homans DV. Peripartum cardiomyopathy. N Engl J Med. 1985; 312: 1432–1427. PubMed: https://pubmed.ncbi.nlm.nih.gov/3887170/
  12. Isogai T, Kamiya CA. Worldwide Incidence of Peripartum Cardiomyopathy and Overall Maternal Mortality. Int Heart J. 2019; 60: 503-511. PubMed: https://pubmed.ncbi.nlm.nih.gov/31019181/
  13. Arany Z, Elkayam U. Peripartum Cardiomyopathy. Circulation. 2016; 133: 1397-409. PubMed: https://pubmed.ncbi.nlm.nih.gov/27045128/
  14. Breen TW, Janzen JA. Pulmonary hypertension and cardiomyopathy: anaesthetic management for Caesarean section. Can J Anaesthe. 1991; 38: 895-899. PubMed: https://pubmed.ncbi.nlm.nih.gov/1742825/
  15. Shaikh N, Ummunnisa F, Chanda A, Imran MA, Ganaw A, et al. Peripartum Cardiomyopathy: Facts and Figures. Tratto da. 2019. https://www.intechopen.com/books/inflammatory-heart-diseases/peripartum-cardiomyopathy-facts-and-figures
  16. Okeke TC, Ezenyeaku C, Ikeako L. Peripartum Cardiomyopathy. Ann Med Health Sci Res. 2013; 3; 313-319. PubMed: https://pubmed.ncbi.nlm.nih.gov/24116305/
  17. Guidelines EC. Cardiovascular Diseases during Pregnancy (Management of) Guidelines. 2018
  18. Lata I, Gupta R, Sahu S, Singh H. Emergency management of decompensated peripartum cardiomyopathy. J Emerg Trauma ShocK. 2009; 2: 124-128. PubMed: https://pubmed.ncbi.nlm.nih.gov/19561973/
  19. Antila S, Sundberg S, Lehtonen LA. Clinical pharmacology of levosimendan. Clin Pharmacokinet. 2007; 46: 535–552. PubMed: https://pubmed.ncbi.nlm.nih.gov/17596101/
  20. Benezet-Mazuecos J, de la Hera J. Peripartum cardiomyopathy: a new successful setting for levosimendan. Int J Cardiol. 2008; 123: 346-347. PubMed: https://pubmed.ncbi.nlm.nih.gov/17324479/
  21. Estrada VHN, Franco DLM, Moreno AAV, Gambasica JAR, Bornacelli YEJ, et al. Reversion of Severe Mitral Insufficiency in Peripartum Cardiomyopathy Using Levosimendan. J Clin Med Res. 2015; 7: 998-1001. PubMed: https://pubmed.ncbi.nlm.nih.gov/26566415/
  22. Sieweke JT, Pfeffer TJ, Berliner D, König T, Hallbaum M, et al. Cardiogenic shock complicating peripartum cardiomyopathy: Importance of early left ventricular unloading and bromocriptine therapy. Eur Heart J Acute Cardiovasc Care. 2020; 9: 173-182. PubMed: https://pubmed.ncbi.nlm.nih.gov/29792513/
  23. Mahmod M, Chan CF, Ali A, Raza S, Wan-Ibrahim NR, et al. Cabergoline as an adjunct for early left ventricular recovery in peripartum cardiomyopathy. Br J Cardiol. 2011; 18: 243-245.
  24. Hilfiker-Kleiner D, Kaminski K, Podewski E, Bonda T, Schaefer A, Sliwa K, et al. A Cathepsin D-Cleaved 16 kDa Form of Prolactin Mediates Postpartum Cardiomyopathy. Cell. 2007; 128: 589-600. PubMed: https://pubmed.ncbi.nlm.nih.gov/17289576/
  25. Bollen IA, V. D. Peripartum cardiomyopathy and dilated cardiomyopathy: different at heart. Front Physiol. 2015; 5. PubMed: https://pubmed.ncbi.nlm.nih.gov/25642195/
  26. Mubarik A, Chippa V, Iqbal AM. Postpartum Cardiomyopathy. StatPearls Publishing. 2020. PubMed: https://www.ncbi.nlm.nih.gov/books/NBK534770/
  27. Shaikh N. An obstetric emergency called peripartum cardiomyopathy! J Emerg Trauma Shock. 2010; 3: 39-42. PubMed: https://pubmed.ncbi.nlm.nih.gov/20165720/
  28. Cowgill JA, Anthracycline SA, Sawyer DB. Peripartum Cardiomyopathies. Circ Res. 2019; 124: 1633-1646. PubMed: https://pubmed.ncbi.nlm.nih.gov/31120822/
  29. Lampert MB, Hibbard J, Weinert L, Briller J, Lindheimer M, et al. Peripartum heart failure associated with prolonged tocolytic therapy. Am J Obstet Gynecol. 1993; 168: 493-495. PubMed: https://pubmed.ncbi.nlm.nih.gov/8438916/
  30. Fett JD, Ansari AA, Sundstrom JB, Combs GF. Peripartum cardiomyopathy: a selenium disconnection and an autoimmune connection. Int J Cardiol. 2002; 86: 311-316. PubMed: https://pubmed.ncbi.nlm.nih.gov/12419571/

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