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Peri-partum cardiomyopathy in a pregnant woman at term revealed by acute pulmonary edema: what to do in front this catastrophic situation?

El ghadbane Abdedaim H, el abidine Benali Z, Omari D, Mohammed D, Hicham B, Charki H - Pan Afr Med J (2014)

Bottom Line: Its incidence ranges from 1/3000 to 1/15000, depending on the region, including much higher in some African countries, it particularly concern women over 30 years, multiparous and multiple pregnancies.The pathogenesis remains unclear, the prognosis is closely related to the complete recovery of cardiac function.We report through the clinical case of a woman aged 33 years admitted to the ICU for acute pulmonary edema of sudden onset of a term pregnancy and what to do before this critical situation.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology & Intensive Care, Military Hospital Mohammed V, University Mohammed V Souissi, Rabat, Morocco.

ABSTRACT
Peripartum cardiomyopathy is insufficient congestive heart occurring in the last month of pregnancy and 5 months after delivery, in the absence of preexisting heart disease and identified etiology. This heart disease is associated with echocardiography systolic dysfunction and left ventricular dilatation. Its incidence ranges from 1/3000 to 1/15000, depending on the region, including much higher in some African countries, it particularly concern women over 30 years, multiparous and multiple pregnancies. The pathogenesis remains unclear, the prognosis is closely related to the complete recovery of cardiac function. We report through the clinical case of a woman aged 33 years admitted to the ICU for acute pulmonary edema of sudden onset of a term pregnancy and what to do before this critical situation.

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A) 2D echocardiography parasternal long axis showing a left ventricular dilatation in diastole with 3.25 cm/m2 (calculated body surface area according to the Mosteller formula: S = √ (L ×M /3600); S is the body surface area in m2, L is the size in cm, M is the mass in kg); B) apical four-chamber view with color Doppler showing mitral regurgitation grade I to II
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Figure 0003: A) 2D echocardiography parasternal long axis showing a left ventricular dilatation in diastole with 3.25 cm/m2 (calculated body surface area according to the Mosteller formula: S = √ (L ×M /3600); S is the body surface area in m2, L is the size in cm, M is the mass in kg); B) apical four-chamber view with color Doppler showing mitral regurgitation grade I to II

Mentions: A woman aged 33 years, iparous, pregnant 38 weeks gestation, normotensive, admitted to the maternity ward for irregular uterine contractions, with history as a nocturnal dry cough appears a week ago with dyspnea NYHA stage II, the standard laboratory tests unremarkable, examination gynecology - obstetrics showed a long cervix closed, six hours after the patient had suddenly unexplained acute dyspnea, the patient was admitted directly to ICU whose examination showed: buccal and cyanosis extremities, dyspnea NYHA stage III, saturation oxygen for 7 liter / min was 85%, blood pressure was 130/80 mm Hg, a temperature of 37 ° c, the cardiopulmonary examination revealed crackling rales in both lung fields levels, tachycardia 96 beats / min without obvious breath, ECG showed: sinus tachycardia, without signs of pulmonary embolism or of myocardial infarction. the bilateral lung ultrasound showed B vertical lines far beyond 3 lines on the ultrasound screen (Figure 1) in favor of acute pulmonary edema, chest radiograph confirms the hypothesis (Figure 2), the echocardiogram showed (Figure 3): a global hypo kinesis with ejection fraction (EF) 40%, a left ventricular dilatation with diastolic dimension: 3.25 cm/m2(body surface area for this patient is 1.6), no right or left atrial dilatation, mitral insufficiency grade I to II, pulmonary arterial hypertension moderate, right ventricular contractility was normal, dry pericardium. Flash a fetal echocardiogram showed bradycardia to 90 beats / min, an indication of emergency caesarean section was landed without loss of time to rescue mother and fetal. patient was placed under furosemide 1 mg / kg in 200 ml of saline serum to pass 5 min, low dose dobutamine 5 gamma / kg / min, who showed echo cardiographic left ventricular positive response in favor of contractile reserves, Premedication consisted of 200 mg cimetidine, hydroxyzine, prophylactic antibiotic therapy based on beta lactam. Throughout the procedure, blood pressure, oxygen saturation, heart rate, urine output, and ECG were Monitored. Spinal anesthesia with isobaric bupivacaine 8 mg of 0.5%, and half Assisi position just after, with nasal oxygen 10 liter / min. The surgeon was advised to expedite its action, extraction of a male baby APGAR score: 8/10 with a weight of 3.5 kg. Anticoagulants curative dose based enoxaparin subcutaneously was established at the tenth hour postoperative, multimodal analgesia, diuretics, filling echo guided, antibiotic prophylaxis for 48 hours. Inhibitors of angiotensin-converting enzyme and the specific beta-blockers started the third day after the stoppage of dobutamine. After seven days, Echocardiography showed ejection fraction 50%.the patient was transferred on the eleventh day in maternity unit with cardiac monitoring.


Peri-partum cardiomyopathy in a pregnant woman at term revealed by acute pulmonary edema: what to do in front this catastrophic situation?

El ghadbane Abdedaim H, el abidine Benali Z, Omari D, Mohammed D, Hicham B, Charki H - Pan Afr Med J (2014)

A) 2D echocardiography parasternal long axis showing a left ventricular dilatation in diastole with 3.25 cm/m2 (calculated body surface area according to the Mosteller formula: S = √ (L ×M /3600); S is the body surface area in m2, L is the size in cm, M is the mass in kg); B) apical four-chamber view with color Doppler showing mitral regurgitation grade I to II
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4214563&req=5

Figure 0003: A) 2D echocardiography parasternal long axis showing a left ventricular dilatation in diastole with 3.25 cm/m2 (calculated body surface area according to the Mosteller formula: S = √ (L ×M /3600); S is the body surface area in m2, L is the size in cm, M is the mass in kg); B) apical four-chamber view with color Doppler showing mitral regurgitation grade I to II
Mentions: A woman aged 33 years, iparous, pregnant 38 weeks gestation, normotensive, admitted to the maternity ward for irregular uterine contractions, with history as a nocturnal dry cough appears a week ago with dyspnea NYHA stage II, the standard laboratory tests unremarkable, examination gynecology - obstetrics showed a long cervix closed, six hours after the patient had suddenly unexplained acute dyspnea, the patient was admitted directly to ICU whose examination showed: buccal and cyanosis extremities, dyspnea NYHA stage III, saturation oxygen for 7 liter / min was 85%, blood pressure was 130/80 mm Hg, a temperature of 37 ° c, the cardiopulmonary examination revealed crackling rales in both lung fields levels, tachycardia 96 beats / min without obvious breath, ECG showed: sinus tachycardia, without signs of pulmonary embolism or of myocardial infarction. the bilateral lung ultrasound showed B vertical lines far beyond 3 lines on the ultrasound screen (Figure 1) in favor of acute pulmonary edema, chest radiograph confirms the hypothesis (Figure 2), the echocardiogram showed (Figure 3): a global hypo kinesis with ejection fraction (EF) 40%, a left ventricular dilatation with diastolic dimension: 3.25 cm/m2(body surface area for this patient is 1.6), no right or left atrial dilatation, mitral insufficiency grade I to II, pulmonary arterial hypertension moderate, right ventricular contractility was normal, dry pericardium. Flash a fetal echocardiogram showed bradycardia to 90 beats / min, an indication of emergency caesarean section was landed without loss of time to rescue mother and fetal. patient was placed under furosemide 1 mg / kg in 200 ml of saline serum to pass 5 min, low dose dobutamine 5 gamma / kg / min, who showed echo cardiographic left ventricular positive response in favor of contractile reserves, Premedication consisted of 200 mg cimetidine, hydroxyzine, prophylactic antibiotic therapy based on beta lactam. Throughout the procedure, blood pressure, oxygen saturation, heart rate, urine output, and ECG were Monitored. Spinal anesthesia with isobaric bupivacaine 8 mg of 0.5%, and half Assisi position just after, with nasal oxygen 10 liter / min. The surgeon was advised to expedite its action, extraction of a male baby APGAR score: 8/10 with a weight of 3.5 kg. Anticoagulants curative dose based enoxaparin subcutaneously was established at the tenth hour postoperative, multimodal analgesia, diuretics, filling echo guided, antibiotic prophylaxis for 48 hours. Inhibitors of angiotensin-converting enzyme and the specific beta-blockers started the third day after the stoppage of dobutamine. After seven days, Echocardiography showed ejection fraction 50%.the patient was transferred on the eleventh day in maternity unit with cardiac monitoring.

Bottom Line: Its incidence ranges from 1/3000 to 1/15000, depending on the region, including much higher in some African countries, it particularly concern women over 30 years, multiparous and multiple pregnancies.The pathogenesis remains unclear, the prognosis is closely related to the complete recovery of cardiac function.We report through the clinical case of a woman aged 33 years admitted to the ICU for acute pulmonary edema of sudden onset of a term pregnancy and what to do before this critical situation.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology & Intensive Care, Military Hospital Mohammed V, University Mohammed V Souissi, Rabat, Morocco.

ABSTRACT
Peripartum cardiomyopathy is insufficient congestive heart occurring in the last month of pregnancy and 5 months after delivery, in the absence of preexisting heart disease and identified etiology. This heart disease is associated with echocardiography systolic dysfunction and left ventricular dilatation. Its incidence ranges from 1/3000 to 1/15000, depending on the region, including much higher in some African countries, it particularly concern women over 30 years, multiparous and multiple pregnancies. The pathogenesis remains unclear, the prognosis is closely related to the complete recovery of cardiac function. We report through the clinical case of a woman aged 33 years admitted to the ICU for acute pulmonary edema of sudden onset of a term pregnancy and what to do before this critical situation.

Show MeSH
Related in: MedlinePlus