Peripartum cardiomyopathy: a disorder requiring high clinical suspicion and evaluation of differential diagnosis

• Type: Summary of Presentation in an International Conference
• Date: 2012

Authors

Rangel I (Author) Other; Gonçalves A (Author) Other; Sousa C (Author) Other; Silva S (Author) Other; Macedo F (Author) Other; Bettencourt P (Author) Other; Maciel MJ (Author) FMUP

Conference proceedings International

Title: European Journal of Heart Failure Supplements

Initial page: P802

Heart Failure Congress 2012

Belgrade, 2012

Scientific classification

FOS: Medical and Health sciences > Clinical medicine

Other information

Abstract (EN): Introduction: Peripartum cardiomyopathy is a rare entity that affects women, who are in late pregnancy or early postpartum period. The clinical evolution is favorable in most cases; however, there are cases with persistent left ventricular dysfunction and consequent poor prognosis. Case Report: We describe the case of a 26 year-old postpartum woman, with a history of Hodgkin's lymphoma treated with anthracycline chemotherapy and autotransplantation for 15 years, with no signs of recurrence. She had no previous cardiovascular symptoms, until the 9th day postpartum, when she was admitted to the emergency room with dyspnoea. Thoracic radiography showed bilateral pleural effusion and suggestive images of bilateral pulmonary infiltrates. The chest angiography computed tomography confirmed the presence of bilateral densification of the lung parenchyma and excluded signs of pulmonary thromboembolism. She was hospitalized in the obstetrics ward with the diagnosis of nosocomial pneumonia, and undergone empiric antibiotic therapy. On physical examination, the patient was tachycardic, normotensive and afebrile. Lung auscultation showed decreased breath sounds with inspiratory crackles at the both lung bases, cardiac auscultation without significant changes and swollen legs. Analytically, it showed anemia, slight elevation of inflammatory markers and elevated BNP levels (1662 pg/mL). Due to this clinical scenario and the lack of symptomatic improvement with antibiotic therapy, the diagnosis of congestive heart failure was gradually suspected. She held an echocardiogram, which showed mild dilation of the left cardiac chambers, with moderate to severe left ventricular systolic dysfunction (LVSD) and moderate mitral regurgitation. Given these data, the clinical suspicion of peripartum cardiomyopathy has been corroborated and therapy for heart failure was optimized. There was a frank symptomatic improvement and she was discharged, oriented to subsequent outpatient follow-up. Conclusion: This case is unique due to the presence of two possible causes of dilated cardiomyopathy: toxic versus peripartum. Based on the timing of symptoms onset, pregnancy-associated cardiomyopathy is the most likely etiology, showing the importance of the high index of clinical suspicion for selection of the most appropriate treatment and careful monitoring.

Language: English

Type (Professor's evaluation): Scientific

Notes: Rangel I, Gonçalves A, Sousa C, Silva S, Macedo F, Bettencourt P, Maciel MJ. Peripartum cardiomyopathy: a disorder requiring high clinical suspicion and evaluation of differential diagnosis. Eur J Heart Fail Suppl 2012; 11(Suppl 1): P802. ISSN 1567-4215. Heart Failure Congress 2012, Belgrade, 2012