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Hakata S, Umegaki T, Soeda T, Nishimoto K, Ando A, Anada N, Uba T, Sumi C, Kamibayashi T. Bromocriptine use for sudden peripartum cardiomyopathy in a patient with preeclampsia: a case report. JA Clin Rep 2019; 5:38. [PMID: 32026046 PMCID: PMC6966983 DOI: 10.1186/s40981-019-0256-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background Peripartum cardiomyopathy is an uncommon form of heart failure that occurs in otherwise healthy women during pregnancy or until 5 months postpartum. Here, we report a rare case where a female patient underwent cesarean section after the occurrence of preeclampsia and intrauterine fetal death, and developed peripartum cardiomyopathy following postsurgical respiratory distress. The prompt initiation of inotropic drug and bromocriptine therapy quickly restored cardiac function. Case presentation The patient was a 36-year-old woman who underwent emergency cesarean section for a previous preeclampsia and an intrauterine fetal death that occurred after 24 weeks of pregnancy. In addition, the patient had an extremely low platelet count of 5000/μL on admission. She had been diagnosed as idiopathic thrombocytopenic purpura at the age of 29 years old and treated with prednisolone at 15 mg/day. Therefore, the cesarean section was performed under general anesthesia. The patient did not exhibit respiratory or hemodynamic dysfunction during surgery. However, she developed respiratory distress with sinus tachycardia after extubation and was transferred to the intensive care unit. A chest radiograph showed butterfly shadows, and transthoracic echocardiogram confirmed the reduction of left ventricle contractility (ejection fraction 20%). She was diagnosed with peripartum cardiomyopathy and treated immediately with intravenous milrinone, oral bromocriptine, and angiotensin-converting enzyme inhibitor. Respiratory and hemodynamic function improved rapidly, and the patient was moved to the general ward 2 days after surgery. Fourteen days after surgery, the patient had an ejection fraction of 57%. The patient recovered without any further complications and was discharged 24 days after surgery. Conclusion A sudden case of peripartum cardiomyopathy was successfully managed by a prompt diagnosis and treatment with inotropic agents and bromocriptine.
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Affiliation(s)
- Saya Hakata
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Takeshi Umegaki
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan.
| | - Takehiro Soeda
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Kota Nishimoto
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Akiko Ando
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Natsuki Anada
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Takeo Uba
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Chisato Sumi
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
| | - Takahiko Kamibayashi
- Department of Anesthesiology, Kansai Medical University Hospital, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan
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Simon R, Yang S, Hameed AB. Bromocriptine Use in Peripartum Cardiomyopathy: Review of Cases. AJP Rep 2018; 8:e335-e342. [PMID: 30473907 PMCID: PMC6249133 DOI: 10.1055/s-0038-1675832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 09/12/2018] [Indexed: 01/14/2023] Open
Abstract
Objective This study is to review published cases of peripartum cardiomyopathy (PPCM) treated with bromocriptine and outline pros and cons of the treatment strategy. Data Sources Data were collected from PubMed/MedLine, ClinicalTrials.gov; the years 2007 to 2018 were searched for English-language articles. Search terms: "bromocriptine and peripartum cardiomyopathy", "bromocriptine and cardiomyopathy." Methods of Study Selection This search strategy yielded 171 articles. After excluding duplicates, 86 studies were reviewed. Sixty-one articles involving the treatment of PPCMP were included, and of these, 17 were case reports of patients with PPCMP treated with bromocriptine; these studies were included in this review. Tabulation, Integration, and Results Seventeen of these articles were case reports of patients with peripartum cardiomyopathy treated with bromocriptine that were included. Conclusion Bromocriptine seems to be a promising treatment, there is currently insufficient evidence for universal utilization of bromocriptine for all patients with PPCMP. Addition of bromocriptine to the standard heart failure therapy should be individualized.
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Affiliation(s)
- Rebecca Simon
- Irvine Department of Obstetrics and Gynecology, University of California, Orange, California
| | - Sophia Yang
- Irvine Department of Obstetrics and Gynecology, University of California, Orange, California
| | - Afshan B Hameed
- Irvine Department of Obstetrics and Gynecology, University of California, Orange, California
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Massou E, Lebon A, Vardon D, Dreyfus M, Benoist G. [Peripartum cardiomyopathy: a rare, unknown and potentially fatal disease]. ACTA ACUST UNITED AC 2013; 41:667-71. [PMID: 24183582 DOI: 10.1016/j.gyobfe.2013.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 08/13/2013] [Indexed: 11/25/2022]
Abstract
Peripartum cardiomyopathy occurs in women with no prior history of cardiac dysfunction, and is presented by left heart failure. It occurs late in pregnancy or in the months after delivery. Rare in Europe, it is not well-known by obstetricians. The prognosis can be good with restitutio in integrum of the maternal cardiac function but the outcome can be dramatic and lead to death of the patient as the case in this report.
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Affiliation(s)
- E Massou
- Normandie Université, 14000 Caen, France; Service de gynécologie-obstétrique et médecine de la reproduction, pôle Femme-Enfant, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
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Abstract
Peripartum cardiomyopathy (PPCM) is a potentially devastating disease that affects women during the last months of pregnancy or the first months after delivery. The aetiology and pathogenesis of this disease remain unclear, but oxidative stress and the generation of a cardiotoxic fragment of prolactin may play key roles. Diagnosing PPCM remains a challenge, as symptoms may mimic those women experience during normal pregnancy and the peripartum period. A high index of suspicion is thus necessary to make the diagnosis. Patients with PPCM have a varied clinical course, as some patients achieve full recovery while others progress to end-stage heart failure and even death. Standard heart failure treatment is indicated, although special provisions are necessary in pregnant and lactating women. Additional research into the pathophysiology of this disease, including possible genetic contributions, may lead to novel treatment strategies that can improve outcomes.
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Affiliation(s)
- Lori A Blauwet
- Division of Cardiovascular Diseases, Mayo Clinic , Rochester, MN , USA
| | - Karen Sliwa
- Hatter Cardiovascular Research Institute, Department of Medicine , Faculty of Health Sciences, University of Cape Town, Cape Town , South Africa
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