Peripartum cardiomyopathy presenting during caesarean section

Area of Science:

• Cardiology
• Obstetrics
• Critical Care Medicine

Background:

• Postpartum collapse presents a diagnostic challenge, often mimicking other critical conditions.
• Peripartum cardiomyopathy (PPCM) is a severe form of heart failure specific to late pregnancy or early postpartum period.
• Pulmonary embolism (PE) is a common concern in the postpartum period, potentially complicating diagnosis.

Purpose of the Study:

• To highlight the importance of considering peripartum cardiomyopathy in postpartum collapse.
• To emphasize the role of early echocardiography and biomarkers in diagnosing PPCM.
• To underscore the necessity of a multidisciplinary approach in managing postpartum cardiac emergencies.

Main Methods:

• Case report of a 30-year-old woman experiencing respiratory distress and shock post-cesarean delivery.
• Utilized chest radiography, CT pulmonary angiography, and point-of-care echocardiography for diagnosis.
• Involved laboratory biomarkers (natriuretic peptide, troponin) and hemodynamic monitoring.
• Initiated guideline-directed medical therapy for heart failure and anticoagulation.

Main Results:

• Initial presentation suggested pulmonary embolism, but echocardiography revealed significant left ventricular systolic dysfunction (LVEF ~35-40%) with elevated cardiac biomarkers.
• Peripartum cardiomyopathy was diagnosed concurrently with a small subsegmental pulmonary embolus.
• The patient responded well to combined heart failure management, vasopressors, diuretics, and anticoagulation.

Conclusions:

• Peripartum cardiomyopathy should be strongly considered in postpartum collapse, even with concurrent findings like pulmonary embolism.
• Prompt echocardiography and cardiac biomarker assessment are vital for accurate and timely diagnosis of PPCM.
• Multidisciplinary management involving cardiology and obstetrics is essential for optimal patient outcomes in these complex cases.