నైరూప్య

Peripartum cardiomyopathy co-existing with severe preeclampsia complicated by AKI

Himleena Gautam

 Introduction: Peripartum cardiomyopathy (PPCM) is a type of dilated cardiomyopathy presenting with heart failure secondary to left ventricle (LV) systolic dysfunction towards the end of pregnancy or in the puerperium, where no other cause of heart failure is found. The incidence of PPCM is around 1 in 2000. It is seen in 2-68% parturient with preeclampsia, but the reason is not known. Acute kidney injury(AKI) in pregnancy is a clinical challenge with significant morbidity and mortality. Studies suggest 1,5-2% incidence of AKI in preeclampsia. Managing PPCM with severe preeclampsia is very challenging and needs combined effort of cardiologist, obstetrician, intensivist, anaesthesiologist, and neonatologist.

Case Report: We present a case of a 34year old woman at 35weeks post IUI pregnancy who presented with severe preeclampsia and pulmonary oedema. Investigations revealed multiorgan involvement and patient was managed in intensive care unit. Supportive management was done with a multidisciplinary approach. Echocardiography showed moderate LV systolic dysfunction and ejection fraction of around 35%, thus suggesting PPCM. Antepartum fetal surveillance was done throughout her stay. On 10th day of admission, she went into labour. She developed acute respiratory distress with anuria and was diagnosed as acute LVF. Emergency LSCS was done under general anaesthesia with cardiac monitoring. A 1.9kg IUGR female baby was delivered. Patient was kept under mechanical ventilation postoperatively. She developed cardiogenic shock but resuscitated. Haemodialysis was done to improve renal function. Gradually she improved clinically and was discharged on 10th post-operative day.

Conclusion: A high index of suspicion is required to diagnose PPCM, especially in cases of preeclampsia as it is difficult to diagnose whether the patient with dyspnea or oedema has heart failure. Early diagnosis and treatment may prevent or lessen symptoms of PPCM and improve maternal and fetal outcomes. A cardiac evaluation is very much necessary even in slightest suspicion in these cases