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Reverse Apical Ballooning Echocardiographic Pattern in Eclampsia-Related Cardiomyopathy

Stephen J Gleich1, David W Barbara, Katherine W Arendt

  • 1From the *Department of Anesthesiology, Mayo Clinic Rochester, Rochester, Minnesota; †Department of Obstetrics and Gynecology, Mayo Clinic Rochester, Rochester, Minnesota; and ‡Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota.

A & a Case Reports
|October 14, 2015
PubMed

The diagnosis of heart failure during pregnancy has important management implications for the parturient and her fetus. A 19-year-old primigravida developed eclampsia at 29 weeks' gestation. Echocardiography demonstrated normal left ventricular size and ejection fraction of 35% with reverse apical ballooning (reverse takotsubo pattern). Under general anesthesia with invasive monitoring, she underwent urgent cesarean delivery of a preterm infant. Follow-up echocardiography 4 weeks after delivery showed complete normalization of her ejection fraction (56%). This case of eclampsia-related stress-induced cardiomyopathy is a distinct entity from peripartum cardiomyopathy. Using echocardiography, the diagnoses should be differentiated with appropriate management and counseling.

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