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Muacevic A, Adler JR, Tayade S, Tayade H. Anesthetic Management in Peripartum Cardiomyopathy: A Contemporary Review. Cureus 2022; 14:e33159. [PMID: 36726888 PMCID: PMC9885382 DOI: 10.7759/cureus.33159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 01/01/2023] Open
Abstract
Peripartum cardiomyopathy (PPCM) is an uncommon disorder of the cardiovascular system and is linked to high rates of morbidity and mortality. It is an idiopathic condition characterized by left ventricular systolic dysfunction with an ejection fraction of approximately 45% near the end of pregnancy or immediately after delivery. Anesthesia management in these women is challenging due to low physiological reserve and potential negative effects on the fetus. To ensure that mother and child are supported safely through delivery, careful anesthesia control is required. Here, in this review article, we discuss the anesthetic implications in preoperative, operative, and postoperative phases in women with perioperative cardiomyopathy undergoing vaginal delivery or cesarean section.
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Ghoreshi ZAS, Akbari H, Sharif-Zak M, Arefinia N, Abbasi-Jorjandi M, Asadikaram G. Recent findings on hyperprolactinemia and its pathological implications: a literature review. J Investig Med 2022; 70:1443-1451. [PMID: 35768141 DOI: 10.1136/jim-2022-002351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 11/03/2022]
Abstract
The prolactin hormone (PRL) is often secreted by lactotrophic cells of the anterior pituitary and has been shown to play a role in various biological processes, including breast feeding and reproduction. The predominant form of this hormone is the 23 kDa form and acts through its receptor (PRLR) on the cell membrane. This receptor is a member of the superfamily of hematopoietic/cytokine receptors. PRL also has a 16 kDa subunit with anti-angiogenic, proapoptotic, and anti-inflammatory effects which is produced by the proteolytic breakdown of this hormone under oxidative stress. Although the common side effects of hyperprolactinemia are exerted on the reproductive system, new studies have shown that hyperprolactinemia has a wide variety of effects, including playing a role in the development of autoimmune diseases and increasing the risk of cardiovascular disease, peripartum cardiomyopathy, and diabetes among others. The range of PRL functions is increasing with the discovery of multiple sites of PRL secretion as well as PRLR expression in various tissues. This review summarizes current knowledge of the biology of PRL and its receptor, as well as the role of PRL in human pathophysiology.
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Affiliation(s)
- Zohreh Al-Sadat Ghoreshi
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Institute of Basic and Clinical Physiology Sciences, Kerman, The Islamic Republic of Iran
| | - Hamed Akbari
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Institute of Basic and Clinical Physiology Sciences, Kerman, The Islamic Republic of Iran.,Department of Clinical Biochemistry, Afzalipur Faculty of Medicine, Kerman University of Medical Sciences, Kerman, The Islamic Republic of Iran
| | - Mohsen Sharif-Zak
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Institute of Basic and Clinical Physiology Sciences, Kerman, The Islamic Republic of Iran.,Neuroscience Research Center, Institute of Neuropharmacology, School of Medicine, Kerman University of Medical Sciences, Kerman, The Islamic Republic of Iran
| | - Nasir Arefinia
- Neuroscience Research Center, Institute of Neuropharmacology, School of Medicine, Kerman University of Medical Sciences, Kerman, The Islamic Republic of Iran
| | - Mojtaba Abbasi-Jorjandi
- Department of Clinical Biochemistry, Afzalipur Faculty of Medicine, Kerman University of Medical Sciences, Kerman, The Islamic Republic of Iran
| | - Gholamreza Asadikaram
- Department of Clinical Biochemistry, Afzalipur Faculty of Medicine, Kerman University of Medical Sciences, Kerman, The Islamic Republic of Iran .,Neuroscience Research Center, Institute of Neuropharmacology, School of Medicine, Kerman University of Medical Sciences, Kerman, The Islamic Republic of Iran
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3
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Abstract
Peripartum cardiomyopathy is a form of idiopathic systolic heart failure which occurs during the end of pregnancy or the early post-partum in the absence of an identifiable etiology. The exact pathogenesis remains unknown, and the incidence is higher in African ancestry, multiparous and hypertensive women, or older maternal age. Delay in diagnosis is common, mainly because symptoms of heart failure mimic those of normal pregnancy. Echocardiography showing decreased myocardial function is at the center of the diagnosis. Management relies on the general guidelines of management of other forms of non-ischemic cardiomyopathy; however, special attention should be paid when choosing medications to ensure fetal safety. Outcomes can be variable and can range from complete recovery to persistent heart failure requiring transplant or even death. High rates of relapse with subsequent pregnancies can occur, especially with incomplete myocardial recovery. Additional research about the etiology, experimental drugs, prognosis, and duration of treatment after recovery are needed.
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Abstract
Gestational hypertension, preeclampsia, and peripartum cardiomyopathy are among the most common and often severe pregnancy-specific cardiovascular diseases (CVDs) and causes of complications in pregnancy. This clinical review provides nurses with an overview of pregnancy-specific CVDs, outlines their pathophysiology, and discusses risk factors and assessment. It describes management interventions according to timing: the antepartum, intrapartum, and postpartum phases are each addressed.
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Niola M, Paternoster M, Paciello L, Giugliano P, Maiellaro A, Feola A, Perna A, Capasso E, Graziano V, Di Lorenzo P, Buccelli C. Sudden unexpected death secondary to peripartum cardiomyopathy. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2019. [DOI: 10.23736/s0393-3660.18.03862-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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6
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Kim MS, Lee JH, Cho HJ, Cho JY, Choi JO, Hwang KK, Yoo BS, Kang SM, Choi DJ. KSHF Guidelines for the Management of Acute Heart Failure: Part III. Specific Management of Acute Heart Failure According to the Etiology and Co-morbidity. Korean Circ J 2019; 49:46-68. [PMID: 30637995 PMCID: PMC6331326 DOI: 10.4070/kcj.2018.0351] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 12/31/2022] Open
Abstract
The prevalence of heart failure (HF) is on the rise due to the aging of society. Furthermore, the continuous progress and widespread adoption of screening and diagnostic strategies have led to an increase in the detection rate of HF, effectively increasing the number of patients requiring monitoring and treatment. Because HF is associated with substantial rates of mortality and morbidity, as well as high socioeconomic burden, there is an increasing need for developing specific guidelines for HF management. The Korean guidelines for the diagnosis and management of chronic heart failure (CHF) were introduced in March 2016. However, CHF and acute heart failure (AHF) represent distinct disease entities. Here, we introduce the Korean guidelines for the management of AHF with reduced or preserved ejection fraction. Part III of this guideline covers management strategies optimized according to the etiology of AHF and the presence of co-morbidities.
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Affiliation(s)
- Min Seok Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ju Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hyun Jai Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jin Oh Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Kuk Hwang
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Byung Su Yoo
- Division of Cardiology, Department of Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seok Min Kang
- Division of Cardiology, Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ju Choi
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
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7
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Minami S, Taniguchi H, Abe T, Doi T, Takeuchi I. Peripartum Cardiomyopathy with Respiratory Failure and Cardiac Arrest. CASE REPORTS IN ACUTE MEDICINE 2018. [DOI: 10.1159/000493665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We describe the case of a 33-year-old female who went into cardiac arrest outside the hospital 7 days postpartum. We diagnosed her with peripartum cardiomyopathy (PPCM). After the return of spontaneous circulation, she suffered from acute pulmonary edema and hypoxia. The patient received intensive care after gaining return of spontaneous circulation. We also present an effective use of venovenous extracorporeal membrane oxygenation (VV-ECMO), which led to a rather short stay in the intensive care unit (ICU). An echocardiogram showed global hypokinesis with an ejection fraction of 28% and a left ventricular dilation with a diastolic dimension. The patient’s lungs recovered steadily during her stay in the ICU. VV-ECMO was disconnected on the seventh day of hospitalization, and intubation was withdrawn on the tenth day. On the thirteenth day, she was released from the ICU and transferred to another hospital. If a pregnant or postpartum woman presents with cardiopulmonary arrest, heart diseases such as PPCM should be considered.
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Bozkurt B, Colvin M, Cook J, Cooper LT, Deswal A, Fonarow GC, Francis GS, Lenihan D, Lewis EF, McNamara DM, Pahl E, Vasan RS, Ramasubbu K, Rasmusson K, Towbin JA, Yancy C. Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e579-e646. [PMID: 27832612 DOI: 10.1161/cir.0000000000000455] [Citation(s) in RCA: 440] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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9
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Akil MA, Bilik MZ, Yildiz A, Acet H, Ertas F, Simsek H, Polat N, Zengin H, Akilli R, Agacayak E, Kayan F, Ozdemir M, Alan S. Peripartum cardiomyopathy in Turkey: Experience of three tertiary centres. J OBSTET GYNAECOL 2016; 36:574-80. [DOI: 10.3109/01443615.2015.1107531] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Mehmet Ata Akil
- Department of Cardiology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey,
| | - Mehmet Zihni Bilik
- Department of Cardiology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey,
| | - Abdulkadir Yildiz
- Department of Cardiology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey,
| | - Halit Acet
- Department of Cardiology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey,
| | - Faruk Ertas
- Department of Cardiology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey,
| | - Hakki Simsek
- Department of Cardiology, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey,
| | - Nihat Polat
- Department of Cardiology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey,
| | - Halit Zengin
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey,
| | - Rabia Akilli
- Department of Cardiology, Faculty of Medicine, Cukurova University, Adana, Turkey, and
| | - Elif Agacayak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Fethullah Kayan
- Department of Cardiology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey,
| | - Mahmut Ozdemir
- Department of Cardiology, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey,
| | - Sait Alan
- Department of Cardiology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey,
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Patel H, Berg M, Barasa A, Begley C, Schaufelberger M. Symptoms in women with Peripartum Cardiomyopathy: A mixed method study. Midwifery 2015; 32:14-20. [PMID: 26515744 DOI: 10.1016/j.midw.2015.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/22/2015] [Accepted: 10/04/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Peripartum Cardiomyopathy is a form of cardiac disease often associated with cardiac failure, occurring in late pregnancy or after childbirth. The anatomical and physiological changes in the mother associated with normal pregnancy are profound, and this may result in symptoms and signs that overlap with Peripartum Cardiomyopathy, leading to missed or delayed diagnosis. Women's experiences of Peripartum Cardiomyopathy symptoms remain poorly studied. The aim of this study was to explore and describe women's experiences of symptoms in Peripartum Cardiomyopathy. DESIGN A triangulation of methods with individual interviews and data from medical records. SETTING Mothers with Peripartum Cardiomyopathy diagnosis were recruited from Western Sweden as a part of research project. PARTICIPANTS 19 women were interviewed and medical records were reviewed by authors. DATA ANALYSIS All interview transcripts were analysed using qualitative inductive content analysis to identify key themes. RESULTS The main theme, meaning of onset and occurrence of symptoms is captured in the metaphor: being caught in a spider web, comprising subthemes, invasion of the body by experienced symptoms and feeling of helplessness. Symptoms related to Peripartum Cardiomyopathy started for 17 women during pregnancy and in two post partum and time from symptoms to diagnosis varied between three and 190 days (median 40). The physical symptoms were:shortness of breath, excessive fatigue and swelling, bloatedness, nausea, palpitation, coughing, chest tightness, bodily pain, headache, fever, tremor, dizziness, syncope, restless and tingly body and reduced urine output. Emotional symptoms were: fear, anxiety, feelings of panic, and thoughts of impending death. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Symptoms of Peripartum Cardiomyopathy were debilitating, exhausting and frightening for the women interviewed in this study. Health care professionals responsible for the antenatal care, especially midwives, need skills to identify initial symptoms of Peripartum Cardiomyopathy for early referral and treatment by a specialist. In order to give optimal care more research is needed to show how to improve midwives' knowledge of Peripartum Cardiomyopathy.
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Affiliation(s)
- Harshida Patel
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
| | - Anders Barasa
- Aga Khan University Hospital, Nairobi, Kenya; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Cecily Begley
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; School of Nursing and Midwifery, Trinity College Dublin, Ireland.
| | - Maria Schaufelberger
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
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Affiliation(s)
- Sarah Grixti
- Foundation Year Doctor in the Department of Internal Medicine, Mater Dei Hospital, Tal-Qroqq, Msida MSD 2090, Malta
| | - Caroline J Magri
- Higher Specialist Trainee, in the Department of Internal Medicine, Mater Dei Hospital, Tal-Qroqq, Msida MSD 2090, Malta
| | - Robert Xuereb
- Consultant Cardiologist in the Department of Cardiac Services, Mater Dei Hospital, Tal-Qroqq, Msida MSD 2090, Malta
| | - Stephen Fava
- Head of the Diabetes and Endocrine Centre, Department of Internal Medicine, Mater Dei Hospital, Tal-Qroqq, Msida MSD 2090, Malta
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Pio M, Afassinou Y, Baragou S, Akue EG, Péssinaba S, Atta B, Ehlan K, Alate A, Damorou F. [Special features of peripartum cardiomyopathy in Africa: the case of Togo on a prospective study of 41 cases at Sylvanus Olympio University Hospital of Lome]. Pan Afr Med J 2014; 17:245. [PMID: 25309645 PMCID: PMC4189861 DOI: 10.11604/pamj.2014.17.245.3058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 03/06/2014] [Indexed: 11/16/2022] Open
Abstract
Introduction La cardiomyopathie du péripartum (CMPP) est une défaillance cardiaque dont l’étiologie demeure encore méconnue. Méthodes Il s'agit d'une étude prospective descriptive réalisée dans le service de cardiologie du CHU Sylvanus olympio de Lomé du 1er janvier 2010 au 30 avril 2012. Elle a concerné 41 patientes ayant présenté une insuffisance cardiaque entre le 8eme mois de la grossesse et les 5 premiers mois du post-partum. Résultats L’âge moyen des patientes était de 31,47 ans (extrêmes 21 et 44ans). L'incidence de la CMPP était de 1/362 grossesses. La parité moyenne était de 3,07 (extrêmes 1 et 6). Les symptômes étaient apparus dans le post-partum dans 90,24% des cas. Un retard important de diagnostic était observé. L'insuffisance cardiaque globale était le mode de décompensation dans 65,85%. Les signes électrocardiographiques étaient essentiellement la tachycardie sinusale (97,56%) et l'hypertrophie ventriculaire gauche (97,56%). L’échographie cardiaque a montré dans tous les cas une cardiomyopathie dilatée. Quatre cas de thrombus intraventriculaire gauche étaient notés. La FEVG était sévèrement altérée. L'HTAP était importante dans 56,09%. Conclusion La cardiomyopathie du péripartum est une complication cardiaque grave de la grossesse de cause inconnue, fréquente dans la population africaine.
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Affiliation(s)
- Machihude Pio
- Service de Cardiologie, Centre Hospitalier Universitaire Sylvanus Olympio (CHU SO) de Lomé
| | - Yaovi Afassinou
- Service de Cardiologie, Centre Hospitalier Universitaire Sylvanus Olympio (CHU SO) de Lomé
| | - Soodougoua Baragou
- Service de Cardiologie. Centre Hospitalier Universitaire Campus de Lomé, Togo
| | - Edem Goeh Akue
- Service de Cardiologie, Centre Hospitalier Universitaire Sylvanus Olympio (CHU SO) de Lomé
| | | | - Borgatia Atta
- Service de Cardiologie, Centre Hospitalier Universitaire Sylvanus Olympio (CHU SO) de Lomé
| | - Koffi Ehlan
- Service de Cardiologie, Centre Hospitalier Universitaire Sylvanus Olympio (CHU SO) de Lomé
| | - Amouzou Alate
- Service de Cardiologie, Centre Hospitalier Universitaire Sylvanus Olympio (CHU SO) de Lomé
| | - Findibe Damorou
- Service de Cardiologie. Centre Hospitalier Universitaire Campus de Lomé, Togo
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Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, Regitz-Zagrosek V, Schaufelberger M, Tavazzi L, van Veldhuisen DJ, Watkins H, Shah AJ, Seferovic PM, Elkayam U, Pankuweit S, Papp Z, Mouquet F, McMurray JJ. Current state of knowledge 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. Eur J Heart Fail 2014; 12:767-78. [PMID: 20675664 DOI: 10.1093/eurjhf/hfq120] [Citation(s) in RCA: 591] [Impact Index Per Article: 59.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Karen Sliwa
- Hatter Cardiovascular Research Institute; University of Cape Town; Cape Town South Africa
| | | | - Mark C. Petrie
- Golden Jubilee National Hospital; West of Scotland Regional Heart Centre; Glasgow UK
| | - Alexandre Mebazaa
- Inserm U 942, Hôpital Lariboisière; Université Paris Diderot; Paris France
| | - Burkert Pieske
- Deparment of Cardiologie; Medical University Graz; Graz Austria
| | - Eckhart Buchmann
- Department of Obstetrics and Gynaecology; University of the Witwatersrand and Chris Hani Baragwanath Hospital; Johannesburg South Africa
| | | | - Maria Schaufelberger
- Department of Medicine; Sahlgrenska University Hospital Ostra; Gothenburg Sweden
| | - Luigi Tavazzi
- Maria Cecilia Hospital - GVM Care & Research; Ettore Sansavini Health Science Foundation; Cotignola Italy
| | - Dirk J. van Veldhuisen
- Department of Cardiology; University Medical Center Groningen; Groningen The Netherlands
| | - Hugh Watkins
- University of Oxford; John Radcliffe Hospital; Oxford UK
| | - Ajay J. Shah
- BHF Centre of Excellence; UK King's College London; UK
| | | | - Uri Elkayam
- Keck School of Medicine; University of Southern California; Los Angeles CA USA
| | - Sabine Pankuweit
- Department of Internal Medicine/Cardiology; Philipp's University Marburg; Marburg Germany
| | - Zoltan Papp
- Division of Clinical Physiology, Faculty of Medicine, Institute of Cardiology; University of Debrecen, Medical and Health Science Center; Debrecen Hungary
| | - Frederic Mouquet
- Polyclinique du Bois, et Pole des maladies cardiovasculaires; Hoptial Cardiologique, Centre Hospitalier Universitaire; Lille France
| | - John J.V. McMurray
- British Heart Foundation Cardiovascular Research Centre; University of Glasgow; Glasgow UK
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Shah T, Ather S, Bavishi C, Bambhroliya A, Ma T, Bozkurt B. Peripartum cardiomyopathy: a contemporary review. Methodist Debakey Cardiovasc J 2013; 9:38-43. [PMID: 23519269 DOI: 10.14797/mdcj-9-1-38] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Peripartum cardiomyopathy is a rare and potentially fatal disease. Though approximately half of the patients recover, the clinical course is highly variable and some patients develop refractory heart failure and persistent left ventricular systolic dysfunction. It is diagnosed when women present with heart failure secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause of heart failure is found. Etiology remains unclear, and treatment is similar to other cardiomyopathies and includes evidence-based standard heart failure management strategies. Experimental strategies such as intravenous immunoglobulin and bromocriptine await further clinical validation.
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Affiliation(s)
- Tina Shah
- Baylor College of Medicine, Houston, Texas, USA
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15
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Abstract
Peripartum cardiomyopathy (PPCM) is a rare form of unexplained cardiac failure of unknown origin, unique to the pregnant woman with highly variable outcome associated with high morbidity and mortality. PPCM is fraught with controversies in its definition, epidemiology, pathophysiology, diagnosis and management. PPCM is frequently under diagnosed, inadequately treated and without a laid down follow-up regimen, thus, the aim of this review. Publications on PPCM were accessed using Medline, Google scholar and Pubmed databases. Relevant materials on PPCM, selected references from internet services, journals, textbooks, and lecture notes on PPCM were also accessed and critically reviewed. PPCM is multifactorial in origin. It is a diagnosis of exclusion and should be based on classic echocardiographic criteria. The outcome of PPCM is also highly variable with high morbidity and mortality rates. Future pregnancies are not recommended in women with persistent ventricular dysfunction because the heart cannot tolerate increased cardiovascular workload associated with the pregnancy. Although, multiparity is associated with PPCM, there is an increased risk of fetal prematurity and fetal loss. PPCM is a rare form of dilated cardiomyopathy of unknown origin, unique to pregnant women. The pathophysiology is poorly understood. Echocardiography is central to diagnosis of PPCM and effective treatment monitoring in patients of PPCM. The outcome is highly variable and related to reversal of ventricular dysfunction.
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Affiliation(s)
- TC Okeke
- Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - CCT Ezenyeaku
- Department of Obstetrics and Gynecology, Anambra State University Teaching Hospital, Awka, Nigeria
| | - LC Ikeako
- Department of Obstetrics and Gynecology, Anambra State University Teaching Hospital, Awka, Nigeria
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16
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Vanzetto G, Martin A, Bouvaist H, Marlière S, Durand M, Chavanon O. [Peripartum cardiomyopathy: A multiple entity]. Presse Med 2012; 41:613-20. [PMID: 22554497 DOI: 10.1016/j.lpm.2012.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 03/26/2012] [Accepted: 03/27/2012] [Indexed: 10/28/2022] Open
Abstract
Peripartum cardiomyopathy (PPCMP) is a dilated and hypokinetic cardiomyopathy occurring during pregnancy or after delivery, with an estimated incidence between 1/1000 and 1/4000 births. It has been defined as a new onset of heart failure in the month preceding or following delivery, without demonstrated aetiology nor previously known heart disease, and with echocardiographic evidences of left ventricular (LV) dysfunction (LV ejection fraction<0.45). It's a multifactorial disease, immunologic, hormonal, and possibly viral mechanisms playing a determinant pathophysiological role. The classical clinical presentation is a rapid and unexpected onset of heart failure in a previously healthy woman, echocardiography being the key examination for positive and differential diagnosis, prognostication, therapeutic decision-making, and follow-up. The potential severity of PPCMP, and its unpredictable evolution in the first days following diagnosis, require that patients be referred to a tertiary care centre with a high skill in intensive cardiology care. Therapeutic management of PPCMP does not offer any specificity when compared to other causes of acute or chronic heart failure (from diuretics to extracorporeal life support), except for ACE-inhibitors, that are contraindicated before delivery. The high incidence of thrombo-embolic complications observed in the disease requires however rapid and curative anticoagulation, and immuno-suppressive treatment has been proposed in fulminant and highly inflammatory presentation, but its efficacy remains controversial. Very recently, promising results have been reported with bromocriptin-a prolactin secretion inhibitor-for reducing 6-month morbidity and mortality, but these findings have to be confirmed in larger scale randomised trials. As for the long-term evolution, approximately half of the patients will heal, while half of the women will keep some degree of LV dysfunction, 25% of them developing moderate to severe chronic heart failure.
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Affiliation(s)
- Gérald Vanzetto
- Centre hospitalier universitaire de Grenoble, cliniques universitaires de cardiologie, BP 217, 38043 Grenoble cedex 7, France.
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17
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Johnson-Coyle L, Jensen L, Sobey A. Peripartum cardiomyopathy: review and practice guidelines. Am J Crit Care 2012; 21:89-98. [PMID: 22381985 DOI: 10.4037/ajcc2012163] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Peripartum cardiomyopathy, a type of dilated cardiomyopathy of unknown origin, occurs in previously healthy women in the final month of pregnancy and up to 5 months after delivery. Although the incidence is low-less than 0.1% of pregnancies -morbidity and mortality rates are high at 5% to 32%. The outcome of peripartum cardiomyopathy is also highly variable. For some women, the clinical and echocardiographic status improves and sometimes returns to normal, whereas for others, the disease progresses to severe cardiac failure and even sudden cardiac death. In acute care, treatment may involve the use of intravenous vasodilators, inotropic medications, an intra-aortic balloon pump, ventricular-assist devices, and/or extracorporeal membrane oxygenation. Survivors of peripartum cardiomyopathy often recover from left ventricular dysfunction; however, they may be at risk for recurrence of heart failure and death in subsequent pregnancies. Women with chronic left ventricular dysfunction should be managed according to guidelines of the American College of Cardiology Foundation and the American Heart Association.
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Affiliation(s)
- Leah Johnson-Coyle
- Leah Johnson-Coyle is a nurse practitioner in cardiac sciences and Alan Sobey is an intensive care physician in the cardiovascular surgery intensive care unit at the Mazankowski Alberta Heart Institute, University of Alberta Hospital, Edmonton, Alberta, Canada. Louise Jensen is a professor in the Faculty of Nursing at the University of Alberta in Edmonton
| | - Louise Jensen
- Leah Johnson-Coyle is a nurse practitioner in cardiac sciences and Alan Sobey is an intensive care physician in the cardiovascular surgery intensive care unit at the Mazankowski Alberta Heart Institute, University of Alberta Hospital, Edmonton, Alberta, Canada. Louise Jensen is a professor in the Faculty of Nursing at the University of Alberta in Edmonton
| | - Alan Sobey
- Leah Johnson-Coyle is a nurse practitioner in cardiac sciences and Alan Sobey is an intensive care physician in the cardiovascular surgery intensive care unit at the Mazankowski Alberta Heart Institute, University of Alberta Hospital, Edmonton, Alberta, Canada. Louise Jensen is a professor in the Faculty of Nursing at the University of Alberta in Edmonton
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18
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Resnick S, Matsuoka L, Cesario D, Darwish A, Selby RR, Sher L. Intra-aortic balloon pump for hemodynamic support in hepatobiliary surgery: report of a case. Surg Today 2012; 42:793-6. [PMID: 22361987 DOI: 10.1007/s00595-012-0150-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 07/15/2011] [Indexed: 11/25/2022]
Abstract
The intra-aortic balloon pump (IABP) can be used transiently to improve cardiac function mechanically, in patients with severe cardiomyopathy and heart failure refractory to medical therapy. In the field of surgery, the IABP is most commonly used for patients with myocardial infarction, congestive heart failure, or other chronic cardiac conditions, who are undergoing cardiac surgery. Conversely, it is rarely used in hepatobiliary surgery, with only two reports found in the literature, excluding cases of emergency cholecystectomy. We describe how we used an IABP successfully during surgery to repair a transected bile duct in a patient with peripartum cardiomyopathy.
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Affiliation(s)
- Shelby Resnick
- Department of Surgery, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA 90033, USA.
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19
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Saltzberg MT, Szymkiewicz S, Bianco NR. Characteristics and Outcomes of Peripartum Versus Nonperipartum Cardiomyopathy in Women Using a Wearable Cardiac Defibrillator. J Card Fail 2012; 18:21-7. [DOI: 10.1016/j.cardfail.2011.09.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 08/29/2011] [Accepted: 09/01/2011] [Indexed: 12/11/2022]
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20
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Munnur U, Bandi V, Guntupalli KK. Management principles of the critically ill obstetric patient. Clin Chest Med 2011; 32:53-60. [PMID: 21277449 DOI: 10.1016/j.ccm.2010.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The goals in management of critically ill obstetric patients involve intensive monitoring and physiologic support for patients with life-threatening but potentially reversible conditions. Management principles of the mother should also take the fetus and gestational age into consideration. The most common reasons for intensive care admissions (ICU) in the United States and United Kingdom are hypertensive disorders, sepsis, and hemorrhage. The critically ill obstetric patient poses several challenges to the clinicians involved in her care, because of the anatomic and physiologic changes that take place during pregnancy.
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Affiliation(s)
- Uma Munnur
- Department of Anesthesiology, Baylor College of Medicine, 1709 Dryden Road, Suite 1700, Houston, TX 77030, USA.
| | - Venkata Bandi
- Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, 1709 Dryden Road, 9th Floor, Houston, TX 77030, USA
| | - Kalpalatha K Guntupalli
- Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, 1709 Dryden Road, 9th Floor, Houston, TX 77030, USA
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21
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Bhakta P, Mishra P, Bakshi A, Langer V. Case report and mini literature review: anesthetic management for severe peripartum cardiomyopathy complicated with preeclampsia using sufetanil in combined spinal epidural anesthesia. Yonsei Med J 2011; 52:1-12. [PMID: 21155028 PMCID: PMC3017683 DOI: 10.3349/ymj.2011.52.1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a rare entity, and anesthetic management for cesarean section of a patient with this condition can be challenging. We hereby present the anesthetic management of a patient with PPCM complicated with preeclampsia scheduled for cesarean section, along with a mini review of literature. A 24 year-old primigravida with twin gestation was admitted to our hospital with severe PPCM and preeclampsia for peripartum care, which finally required a cesarean section. Preoperative optimization was done according to the goal of managing left ventricular failure. Combined spinal epidural (CSE) anaesthesia with bupivacaine and sufentanil was used for cesarean section under optimal monitoring. The surgery was completed without event or complication. Postoperative pain relief was adequate and patient required only one epidural top up with sufentanil 6 hours after operation. To the best of our knowledge there is no report in literature of the use of sufentanil as a neuraxial opioid in the anesthetic management of cesarean section in a patient with PPCM. CSE with sufentanil may be a safer and more effective alternative in such cases.
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Affiliation(s)
- Pradipta Bhakta
- Department of Anesthesiology, Sultan Quaboos University Hospital, Muscat, Sultanate of Oman
| | - Pragnyadipta Mishra
- Department of Anesthesiology, University of Florida College of Medicine-Jacksonville, Fl, USA
| | - Anamika Bakshi
- Department of Anesthesiology, Moolchand Hospital, New Delhi, India
| | - Vijay Langer
- Department of Anesthesiology, Moolchand Hospital, New Delhi, India
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22
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Abstract
Various clinical disorders can cause hyperthyroidism, the effects of which vary according to the patient's age, severity of clinical presentation and association with other comorbidities. Hyperthyroidism is associated with increased morbidity and mortality from cardiovascular disease, although whether the risk of specific cardiovascular complications is related to the etiology of hyperthyroidism is unknown. This article will focus on patients with Graves disease, toxic adenoma and toxic multinodular goiter, and will compare the cardiovascular risks associated with these diseases. Patients with toxic multinodular goiter have a higher cardiovascular risk than do patients with Graves disease, although cardiovascular complications in both groups are differentially influenced by the patient's age and the cause of hyperthyroidism. Atrial fibrillation, atrial enlargement and congestive heart failure are important cardiac complications of hyperthyroidism and are prevalent in patients aged > or = 60 years with toxic multinodular goiter, particularly in those with underlying cardiac disease. An increased risk of stroke is common in patients > 65 years of age with atrial fibrillation. Graves disease is linked with autoimmune complications, such as cardiac valve involvement, pulmonary arterial hypertension and specific cardiomyopathy. Consequently, the etiology of hyperthyroidism must be established to enable correct treatment of the disease and the cardiovascular complications.
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Affiliation(s)
- Bernadette Biondi
- Department of Clinical and Molecular Endocrinology and Oncology, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy. @libero.it
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23
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Joseph R, Coker M. Postpartum complete heart block in a healthy patient. J OBSTET GYNAECOL 2010; 30:314. [PMID: 20373942 DOI: 10.3109/01443610903576274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- R Joseph
- Department of Obstetrics and Gynaecology, Watford General Hospital, London, UK.
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24
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Desai P. Peripartum Cardiomyopathy: A review. J Obstet Gynaecol India 2010. [DOI: 10.1007/s13224-010-0013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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