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Greatorex B, Colebourn C, Ormerod O. Echocardiographic assessment and critical care management of peri-partum women with unexpected left ventricular failure. J Intensive Care Soc 2022; 23:210-221. [PMID: 35615233 PMCID: PMC9125437 DOI: 10.1177/1751143720978862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION Cardiac disease remains the largest single cause of maternal death. Whilst uncommon, left ventricular failure during pregnancy and delivery can be devastating to both mother and child. Echocardiography can play a significant role in rapidly establishing a diagnosis, guiding initial therapy and then monitoring response. CLINICAL VIGNETTES The history, presentation and management of three cases of peri-partum left ventricular failure is examined: stress cardiomyopathy in a 34 year old with twins, left ventricular dysfunction secondary to pre-eclampsia in a 22 year old with a singleton pregnancy and a true peri-partum cardiomyopathy in a 42 year old with IVF twins. The defining risk factors, presenting characteristics and echocardiographical findings for each pathology are highlighted. CONCLUSION Echocardiography is playing an increasingly important role in the immediate assessment and management of left ventricular failure. This is especially true in the peri-partum woman, where establishing the correct therapy is both challenging and crucial due to the significant cardiovascular changes that occur around the time of delivery. To this end we believe that echocardiography should be rapidly available to guide the management of these patients by a multidisciplinary team made up of obstetricians, cardiologists, anaesthetists and intensive care physicians.
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Affiliation(s)
- Ben Greatorex
- Department of Anaesthesia and
Intensive Care, Raigmore Hospital, NHS Highlands, Inverness, UK
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2
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Bucciarelli-Ducci C, Ostenfeld E, Baldassarre LA, Ferreira VM, Frank L, Kallianos K, Raman SV, Srichai MB, McAlindon E, Mavrogeni S, Ntusi NAB, Schulz-Menger J, Valente AM, Ordovas KG. Cardiovascular disease in women: insights from magnetic resonance imaging. J Cardiovasc Magn Reson 2020; 22:71. [PMID: 32981527 PMCID: PMC7520984 DOI: 10.1186/s12968-020-00666-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
The presentation and identification of cardiovascular disease in women pose unique diagnostic challenges compared to men, and underrecognized conditions in this patient population may lead to clinical mismanagement.This article reviews the sex differences in cardiovascular disease, explores the diagnostic and prognostic role of cardiovascular magnetic resonance (CMR) in the spectrum of cardiovascular disorders in women, and proposes the added value of CMR compared to other imaging modalities. In addition, this article specifically reviews the role of CMR in cardiovascular diseases occurring more frequently or exclusively in female patients, including Takotsubo cardiomyopathy, connective tissue disorders, primary pulmonary arterial hypertension and peripartum cardiomyopathy. Gaps in knowledge and opportunities for further investigation of sex-specific cardiovascular differences by CMR are also highlighted.
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Affiliation(s)
- Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol National Institute of Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol and University of Bristol, Bristol, UK
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital Lund, Lund University, Getingevägen 5, SE-22185 Lund, Sweden
| | | | - Vanessa M. Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Luba Frank
- University of Texas Medical Branch, Galveston, TX USA
| | | | | | | | - Elisa McAlindon
- Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
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3
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De Viti D, Malvasi A, Busardò F, Beck R, Zaami S, Marinelli E. Cardiovascular Outcomes in Advanced Maternal Age Delivering Women. Clinical Review and Medico-Legal Issues. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E658. [PMID: 31569595 PMCID: PMC6843194 DOI: 10.3390/medicina55100658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023]
Abstract
Background and objecives: Adverse cardiovascular outcomes during pregnancy have increased over the past few decades, with increased numbers of women delivering later in their reproductive life. Other factors include higher rates of female obesity, diabetes, hypertension, cardiovascular diseases and assisted reproductive technology, which has extended fertility. Those at risk require extensive prenatal maternal screening, constant pregnancy supervising, monitoring during labor, delivery and puerperium and careful anesthetic evaluation during delivery. Materials and Methods: The present review reports the relevant information available on cardiovascular outcomes in advanced maternal age delivering women and related medico-legal issues. The search was performed on Pubmed, Cochrane, Semantic Scholar, Medline and Embase databases, accessed by Ovid, including among others the terms "cardiomyopathy", "ischaemic heart disease", "arrhythmias", "hypertension", "peripartum period", "diabetes", "advanced maternal age" "anesthesia", "maternal morbidity and mortality" and "litigation". Results: To the extent that underestimating risk factors for peripartum cardiomyopathy (PPCM) can adversely impact maternal and fetal outcomes, the legal implications of misdiagnosis or mismanagement can result in high compensatory damages. Substantial indemnity payments drive up costs of insurance coverage. Conclusions: Multidisciplinary approaches are necessary from obstetricians, cardiologists, anesthesiologists and perinatologists for pregnancy monitoring and delivery outcomes.
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Affiliation(s)
- Daniele De Viti
- Department of Cardiology, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy.
| | - Antonio Malvasi
- Department of Obstetrics and Gynecology, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy.
| | - Francesco Busardò
- Section of Legal Medicine, Università Politecnica delle Marche, 60120 Ancona, Italy.
| | - Renata Beck
- Department of Anesthesia and Analgesia, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy.
| | - Simona Zaami
- Unit of Forensic Toxicology (UoFT), Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University, 00161 Rome, Italy.
| | - Enrico Marinelli
- Unit of Forensic Toxicology (UoFT), Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University, 00161 Rome, Italy.
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Cohen KM, Minehart RD, Leffert LR. Anesthetic Treatment of Cardiac Disease During Pregnancy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:66. [PMID: 30019160 DOI: 10.1007/s11936-018-0657-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the pathophysiology, peripartum treatment, and anesthetic management of parturients with cardiac disease. Valvular disease, coronary disease, and cardiomyopathy are specifically addressed in the context of the normal physiologic changes of pregnancy. We offer recommendations for anesthetic approaches, hemodynamic goals with an emphasis on interdisciplinary planning between anesthesiologists, cardiologists, cardiothoracic surgeons, obstetricians, maternal fetal medicine specialists, and neonatologists. RECENT FINDINGS Vaginal delivery with neuraxial analgesia can be well tolerated by many pregnant patients with cardiac disease when coordinated by an interdisciplinary team of experts. Cardiac disease in pregnancy can present a significant challenge for the interdisciplinary care team. A detailed understanding of each patient's cardiac pathology and the physiologic changes of pregnancy are critical to ensure a safe and successful labor and delivery. Optimized medical therapy in the peripartum period and neuraxial anesthesia with the judicious use of vasoactive agents can be of great benefit for these parturients. As is generally the case, cesarean delivery should be primarily reserved for obstetric indications and maternal wellbeing, with careful consideration of the fetus to guide best practices.
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Affiliation(s)
- Kate M Cohen
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Rebecca D Minehart
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Lisa R Leffert
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
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5
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Olejárová I, Pavlíková M, Hulman M, Artemiou P, Beňa M, Gašparovič I, Hudec V. Successful treatment of peripartum cardiomyopathy with mechanical assist devices and cardiac transplantation. COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2017.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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6
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Gupta D, Wenger NK. Peripartum cardiomyopathy: Status 2018. Clin Cardiol 2018; 41:217-219. [PMID: 29451958 PMCID: PMC6490057 DOI: 10.1002/clc.22888] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 12/28/2017] [Accepted: 01/03/2018] [Indexed: 11/05/2022] Open
Abstract
Peripartum cardiomyopathy is a rare cardiac condition, overall. However, in certain populations can be found frequently enough and the signs, symptoms, and management should be readily understood. Here we provide an updated overview of this topic.
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Affiliation(s)
- Divya Gupta
- Division of CardiologyEmory University HospitalAtlantaGeorgia
| | - Nanette K. Wenger
- Division of CardiologyEmory University School of Medicine, Grady Memorial HospitalAtlantaGeorgia
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7
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Bhatia PK, Biyani G, Mohammed S, Sethi P, Bihani P. Acute respiratory failure and mechanical ventilation in pregnant patient: A narrative review of literature. J Anaesthesiol Clin Pharmacol 2016; 32:431-439. [PMID: 28096571 PMCID: PMC5187605 DOI: 10.4103/0970-9185.194779] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Physiological changes of pregnancy imposes higher risk of acute respiratory failure (ARF) with even a slight insult and remains an important cause of maternal and fetal morbidity and mortality. Although pregnant women have different respiratory physiology and different causes of ARF, guidelines specific to ventilatory settings, goals of oxygenation and weaning process could not be framed due to lack of large-scale randomized controlled trials. During the 2009 H1N1 pandemic, pregnant women had higher morbidity and mortality compared to nonpregnant women. During this period, alternative strategies of ventilation such as high-frequency oscillatory ventilation, inhalational of nitric oxide, prone positioning, and extra corporeal membrane oxygenation were increasingly used as a desperate measure to rescue pregnant patients with severe hypoxemia who were not improving with conventional mechanical ventilation. This article highlights the causes of ARF and recent advances in invasive, noninvasive and alternative strategies of ventilation used during pregnancy.
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Affiliation(s)
- Pradeep Kumar Bhatia
- Department of Anaesthesiology and Critical Care, All Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ghansham Biyani
- Department of Anaesthesiology and Critical Care, All Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sadik Mohammed
- Department of Anaesthesiology and Critical Care, Dr. S.N. Medical College, Jodhpur, Rajasthan, India
| | - Priyanka Sethi
- Department of Anaesthesiology and Critical Care, All Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pooja Bihani
- Department of Anaesthesiology and Critical Care, All Institute of Medical Sciences, Jodhpur, Rajasthan, India
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8
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Dinic V, Markovic D, Savic N, Kutlesic M, Jankovic RJ. Peripartum Cardiomyopathy in Intensive Care Unit: An Update. Front Med (Lausanne) 2015; 2:82. [PMID: 26636086 PMCID: PMC4655438 DOI: 10.3389/fmed.2015.00082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/02/2015] [Indexed: 11/17/2022] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a systolic heart failure that occurs during the last month of pregnancy or within 5 months after delivery. It is an uncommon disease of unknown etiopathogenesis and has a very high rate of maternal mortality. Because of similarity between symptoms of PPCM and physiological discomforts during pregnancy, the early diagnosis of PPCM presents a major challenge. Since hemodynamic changes during PPCM can vitally jeopardize the mother and the fetus, patients with severe forms of PPCM require a multidisciplinary approach in intensive care units. This review summarizes the current state of knowledge about the diagnosis, monitoring, and the treatment of PPCM. Having reviewed the recent researches, it gives insight into the new treatment strategies of this rare disease.
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Affiliation(s)
- Vesna Dinic
- Center for Anesthesiology and Reanimatology, Clinical Center of Nis , Nis , Serbia
| | - Danica Markovic
- Center for Anesthesiology and Reanimatology, Clinical Center of Nis , Nis , Serbia
| | - Nenad Savic
- Center for Anesthesiology and Reanimatology, Clinical Center of Nis , Nis , Serbia
| | - Marija Kutlesic
- Center for Anesthesiology and Reanimatology, Clinical Center of Nis , Nis , Serbia
| | - Radmilo J Jankovic
- Center for Anesthesiology and Reanimatology, Clinical Center of Nis , Nis , Serbia ; Department for Anesthesiology and Intensive Care, School of Medicine, University of Nis , Nis , Serbia
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9
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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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10
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Use of a single-circuit CentriMag® for biventricular support in postpartum cardiomyopathy. Perfusion 2012; 28:156-9. [DOI: 10.1177/0267659112464713] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Peripartum cardiomyopathy (PPCM) is defined by acute heart failure in the late stages of pregnancy to a few months postpartum. Cardiogenic shock in PPCM, though rare, can be life-threatening, often requiring support with mechanical circulatory support devices. We present a case of 37-year-old Caucasian female who developed cardiogenic shock within 24 hours of the delivery of her twins. The echocardiogram demonstrated severe biventricular failure which necessitated biventricular device placement and support with a CentriMag® centrifugal pump. This biventricular support was employed, using a single-circuit CentriMag® pump, using a ‘Y’ connection which made weaning from right-sided support and conversion to univentricular support easier and feasible. The patient recovered four weeks later and was explanted off the CentriMag® support and did well. This technology allows for the CentriMag® to be considered as an early option for biventricular support in the treatment and management of these patients as a bridge to recovery.
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11
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Abstract
Obstetrical critical care has not been able to achieve the same level of peaks in developing nations like India, as in the western countries. Numerous factors, including clinical and economical, have played a major role in widening the gap of quality care delivery in severely ill obstetric patients, between the two extreme worlds. Moreover, this wide gap can be, to a large extent, attributable to the lower literacy rates, paucity of research in obstetrical critical care, poverty, lack of awareness, and the sociocultural and behavioral factors prevalent in these developing nations. The most common indication for Intensive Care Unit (ICU) admission of such patients throughout the world is hemorrhage, both antepartum and postpartum. Hypertensive disorders, pre-eclampsia, and its related complications are also major contributory factors for such admissions. The pattern of the disease necessitating such admissions influences maternal mortality to a great extent. The present article reviews the most common indications of obstetrical admissions to the ICU, the challenges and obstacles in the treatment of severely ill obstetric patients, their possible outcome in the developing nations, room for improvement, and the need for a change in the system for better delivery of critical care obstetrical services.
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Affiliation(s)
- Sukhwinder Kaur Bajwa
- Department of Obstetrics and Gynaecology, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
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12
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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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13
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Yun SY, Cho KH, Lee HM, Lee DH, Choi YH. A Case of Cardiac Arrest Caused by Peripartum Cardiomyopathy. HONG KONG J EMERG ME 2010. [DOI: 10.1177/102490791001700313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Many women experience dyspnoea, orthopnoea, and peripheral oedema during pregnancy, and diagnosing cardiac problem is confounded by these signs and symptoms of normal pregnancy. Peripartum cardiomyopathy (PPCM) is a rare life-threatening cardiomyopathy of unknown aetiology that occurs between the last month of pregnancy and the first 5 months postpartum in previously healthy woman. Multiparity, twins, advanced maternal age, preeclampsia, gestational hypertension, and black race are known risk factors. The course of PPCM can range from readily treatable to acutely fatal. We present a lady with dyspnoea in the peripartum period admitted in cardiac arrest as a result of PPCM.
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Zimmerman H, Bose R, Smith R, Copeland JG. Treatment of Peripartum Cardiomyopathy With Mechanical Assist Devices and Cardiac Transplantation. Ann Thorac Surg 2010; 89:1211-7. [DOI: 10.1016/j.athoracsur.2009.12.064] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 12/26/2009] [Accepted: 12/30/2009] [Indexed: 10/19/2022]
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15
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Egan DJ, Bisanzo MC, Hutson HR. Emergency Department Evaluation and Management of Peripartum Cardiomyopathy. J Emerg Med 2009; 36:141-7. [DOI: 10.1016/j.jemermed.2007.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2005] [Revised: 07/07/2006] [Accepted: 11/13/2006] [Indexed: 11/28/2022]
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16
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Bosch M, Santema J, van der Voort P, Bams J. A serious complication in the puerperium: peripartum cardiomyopathy. Neth Heart J 2008; 16:415-8. [PMID: 19127319 PMCID: PMC2612110 DOI: 10.1007/bf03086189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Two women, aged 27, presented with different symptoms shortly after giving birth to their first child. Peripartum cardiomyopathy (PPCM) was diagnosed. PPCM is a rare form of cardiac failure occurring late in pregnancy or in the postpartum period. Many women experience dyspnoea, fatigue, and pedal oedema in the last month of pregnancy or postpartum, symptoms which are identical to early congestive heart failure. Therefore, the diagnosis of PPCM requires vigilance. A high mortality rate and overall poor clinical outcome has been reported in a high percentage of these patients. Subsequent pregnancies remain controversial. (Neth Heart J 2008;16:415-8.).
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Affiliation(s)
- M.G.E. Bosch
- Department of Obstetrics and Gynaecology, Medical Centre Leeuwarden, the Netherlands
| | - J.G. Santema
- Department of Obstetrics and Gynaecology, Medical Centre Leeuwarden, the Netherlands
| | - P.H.J. van der Voort
- Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - J.L. Bams
- Intensive Care Unit, University Medical Center Groningen, Groningen, the Netherlands
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18
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Menias CO, Elsayes KM, Peterson CM, Huete A, Gratz BI, Bhalla S. CT of pregnancy-related complications. Emerg Radiol 2007; 13:299-306. [PMID: 17216173 DOI: 10.1007/s10140-006-0570-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2006] [Accepted: 12/13/2006] [Indexed: 10/23/2022]
Abstract
During pregnancy, the risk of radiation exposure to the fetus is increased so that more than the usual benefit is necessary to justify computed tomography (CT; or other radiation exposure) than in non-pregnant patients. In the setting of a life-threatening illness, CT may be indicated to assess for potentially fatal complications such as hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. After delivery, patients rarely develop serious problems requiring radiologic evaluation. When indicated, however, CT may be invaluable in making the diagnosis or determining the severity of peri- and post-partum complications, including uterine perforation, hemorrhage, endometritis, thrombophlebitis, and abscess formation. At times, CT may be the first to uncover conditions, such as post-partum cardiomyopathy, and heart failure, which are usually diagnosed by other modalities but may explain the symptoms for which the study was ordered. In some centers, CT pulmonary angiography represents the standard of care to diagnose pulmonary thromboembolism. In this article, we illustrate the spectrum of peri-partum and post-partum complications on CT to familiarize the radiologist with the CT features of these potentially life-threatening pregnancy-related complications.
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Affiliation(s)
- Christine O Menias
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO, USA
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19
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20
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Reimold SC, Forbess LW. Pharmacologic Options for Treating Cardiovascular Disease During Pregnancy. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50047-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Stoneham AE, Graham J, Rozanski EA, Rush JE. Pregnancy-Associated Congestive Heart Failure in a Cat. J Am Anim Hosp Assoc 2006; 42:457-61. [PMID: 17088393 DOI: 10.5326/0420457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 4-year-old, late-term pregnant Himalayan queen was diagnosed with biventricular congestive heart failure characterized by pleural effusion and pulmonary edema. A cesarean section was performed, resulting in the birth of four live kittens, with one surviving to discharge. Congestive heart failure resolved rapidly following surgery. The queen remained asymptomatic for 9 years postoperatively. Volume expansion secondary to pregnancy was thought to result in cardiovascular volume overload and subsequent congestive heart failure.
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Affiliation(s)
- Anne E Stoneham
- Department of Clinical Sciences, School of Veterinary Medicine, Tufts University, 200 Westboro Road, North Grafton, Massachusetts 01536, USA
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22
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Abstract
Peripartum cardiomyopathy is a rare and under recognized form of dilated cardiomyopathy, defined as a heart failure in the last month of pregnancy or in the first five months post-partum with absence of determinable cause for cardiac failure and absence of demonstrable heart disease. The incidence of peripartum cardiomyopathy ranges from 1 in 1300 to 1 in 15,000 pregnancy. Advanced maternal age, multiparity, twin births, preeclampsia and black race are known risk factors. The etiology of peripartum cardiomyopathy remains unknown but viral, autoimmune or idiopathic myocarditis are highly suggested. The clinical presentation on patients with peripartum cardiomyopathy is similar to that of patients with systolic heart failure. The treatment is based on drugs for sympyomatic control. Studies in graeter populations are need to determine the role of immunosupressive treatment. About half patients of peripartum cardiomyopathy recover. The left ventricular ejection fraction and the left ventricular end-diastolic diameter are statistically significant prognostic factors. The risk of developing peripartum cardiomyopathy in subsequent pregnancies remains high. The place of dobutamine stress test in counseling the patients who desire pregnancy must be more studied.
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Affiliation(s)
- S Fennira
- Service de Cardiologie et Angiologie, CHU Mongi-Slim, Tunisie.
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23
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Martin SR, Foley MR. Intensive care in obstetrics: an evidence-based review. Am J Obstet Gynecol 2006; 195:673-89. [PMID: 16949397 DOI: 10.1016/j.ajog.2006.05.042] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Revised: 03/05/2006] [Accepted: 05/30/2006] [Indexed: 11/26/2022]
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Morton A, Kannan S. Case report: Peripartum cardiomyopathy in a woman with hypopituitarism. BJOG 2005; 113:123-4. [PMID: 16398783 DOI: 10.1111/j.1471-0528.2005.00807.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Adam Morton
- Mater Hospital, South Brisbane, QLD, Australia
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de Beer T. Peripartum Cardiomyopathy in a DGH Setting — Case Report and Literature Review. J Intensive Care Soc 2005. [DOI: 10.1177/175114370500600313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Thearina de Beer
- SpR Anaesthetics and ICM Oxford Rotation Milton Keynes General Hospital
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