Skip to main content

Peripartum Cardiomyopathy

Peripartum Cardiomyopathy (PPCM)

•       Usually develops in last month of pregnancy or first 5 months post-delivery.

•       Presents as heart failure with reduced ejection fraction (dilated cardiomyopathy)

↳      LV EF < 45% 

•       PPCM is a diagnosis of exclusion.

•       Risk factors →

1-    History of Hypertension, Pre-eclampsia

2-    Black women

•       Incidence → 1 in 2000 live births.

•       Management →

1.     Guideline directed medical therapy for HF-
Beta-blockers
Hydralazine plus isosorbide dinitrate 

Diuretics

2.     Bromocriptine

3.     Low threshold for anticoagulation

4.     ACE inhibitors and ARBs are contraindicated before delivery.

5.     Safety of ARNI and SALT-2 inhibitors in not clear at present.

 

•       Mode of delivery: Vaginal delivery is preferred.

•       If LV dysfunction persists, avoid future pregnancies.

•       Prognosis →

1.     About half of the patients will recover.

2.     And half will have some degree of LV dysfunction.

3.     Approximately 25% of patients with LV dysfunction will have moderate to severe LV dysfunction.

•       Fett probability scoring → For diagnosis of PPCM

Comments

Post a Comment

Popular posts from this blog

ECG Quiz

Case History:  A 46-year old female presents with history of palpitations.  At the time of palpitations, she also had rapid neck pulsations.  She presented to emergency and an ECG was done.  What are the findings?  What is the diagnosis?   Click here to reveal the answer The ECG shows a regular narrow complex tachycardia (ventricular rate of approximately 250/min). The P waves are not clearly visible, but there is a small deflection at the end of QRS in various leads. In lead I, this is pseudo r' and in leads this is pseudo s wave. The patient was found to have AVNRT on EPS and slow pathway was ablated successfully.  
Post a Comment
Read more

Coronary artery perforation

  Management of coronary artery perforation 1.       Balloon inflation for occlusion of vessel 2.       General circulatory support → Intravenous fluids and vasopressors 3.       Urgent pericardiocentesis if cardiac tamponade (may consider autotransfusion) 4.       Call anaesthetist and inform surgeons. Repeat angiogram ↓ Extravasation settled → Yes → Monitor patient ↓ No #        Large vessel perforation 1.       Prolonged balloon inflation 2.       Covered stent placement #        Small distal vessel perforation 1.       Embolization (fat, coils, thrombin, balloon fragment) 2.       Covered stent in main vessel over perforated branch origin
Post a Comment
Read more