A case of peripartum cardiomyopathy in primary care
Introduction: Peripartum cardiomyopathy (PKM) is a form of congestive heart failure that results from an enlarging of the heart and a weakening of the heart muscle in the last month of pregnancy and in the first five months of the postnatal period. Major risk factors include pregnancy at >30 years of age, multiparity, chronic hypertension and eclampsia. Patients suffering from PKM generally present with symptoms akin to heart failure, and the condition can be considered normal during the late period of pregnancy. A diagnosis of PKM can be made from anamnesis, a physical examination and echocardiography.
Case Presentation: A 34-year old female patient, visiting the family medicine polyclinic for vaccinations of her 1-month-old infant, was noted to be suffering from shortness of breath, palpitations and coughing. There was no medical history of any disease or medication before or during the pregnancy. The patient’s blood pressure was 120/70 mmHg and her pulse was rhythmic at 122/min. There was no cardiac murmur, rales were present in both pulmonary bases and the results of an abdominal examination were normal. Pitting edemas were observed in both lower extremities, and a further anamnesis revealed that the patient’s palpitations had begun two weeks prior to the birth, and had increased in the first postpartum week. The patient was transferred to a cardiologist due to concerns of heart failure and a pulmonary embolism, and was then admitted to the intensive care unit for treatment with a diagnosis of acute decompensated heart failure.
Conclusion: Given the higher incidence of disease in mothers >30 years, and the advanced average age of maternity in the present day, the odds of encountering PKM in the primary care is increasing. Family physicians can overcome this low-prevalence of the disease by investigating risk factors, following-up symptoms and consulting experts.
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Peripartum Cardiomyopathy Michael M. Givertz, MD Circulation. 2013;127:e622-e626.) © 2013 American Heart Association, Inc. DOI: 10.1161/CIRCULATIONAHA.113.001851
Peripartum Cardiomyopathy Ümran Koçak, Derya Tok, Göktürk İpek Abant Medical Journal Volume Cilt 2 Issue Sayı 2 Year Yıl 2013 doi: 10.5505/abantmedj.2013.26818
Journal of the American College of Cardiology Vol. 58, No. 7, 2011 (no:4)
Peripartum Cardiomyopathy VN Mishra, Nalini Mishra, Devanshi : JAPI April 2013 Vol:61
Demakis JG, rahimtoola SH; Peripartum Cardiomyopathy. Circulation 1971;44;964-68.
Witlin AG, Mabie WC, Sibai BM. Peripartum cardiomypathy: an omnious diagnosis. Am j Obstet Gynecol 2008;199: e5-6
Mielniczuk LM, Williams L, Davis DR, et al. Frequency of peripartum cardiomyopathy. Am J Cardiol 2006;97:1765-8
Amos A, Jaber WA, Russel SD. Improved outcomes in peripartum cardiomyopathy with contemporary. Am Heart J 2006;152:509-13
Goland S, Modi K, Bitar F, et al. Clinical profile and predictors ofcomplications in peripartum cardiomyopathy. J Card Fail 2009;15: 645–50.
Groesdonk HV, Dinse- Lambracht A, Doblanzki W, Doblanzki U,Galm C, Muth C-M. Unrecognized peripartum cardiomyopathy,case series and comprehensive review of literature. Appl Cardiopulm Pathophysiol 2009;13:237– 42.
Kaaja R. Peripartum cardiomyopathy. Minerva Cardioangiol 2006; 543: 331–6.
Person GD, Veille JC, Rahimtoola S. et al. Peripartum cardiomyopathy: National Heart,Lung and Blood Institute and Office of Rare Diseases (National Instutes of Health) workshop recommendations and review. JAMA 2000;283:1183-8