Peripartum cardiomyopathy (clinical case)

Abstract

Introduction. Peripartum cardiomyopathy (PPKMP) is a rare cause of heart failure (CHF) in healthy women during pregnancy and within 5 months after delivery. Case report. A 33-year-old female patient, a native of Tajikistan, first developed shortness of breath and edema of the lower extremities at the 35th week of her third pregnancy. Cesarean section was performed at 39 weeks. Symptoms progressed within 3 months of the postpartum period, hepatomegaly, ascites and hydrothorax appeared. Echocardiography revealed heart chambers dilation, reduced left ventricular ejection fraction (26%), diffuse hypokinesis. The diagnosis of PPCM was established. Perindopril, bisoprolol, spironolactone, furosemide, bromocriptine, heparin were prescribed. The severity of HF symptoms decreased significantly during 12 days of treatment. Discussion. PPCM is a diagnosis of exclusion. Myocarditis, dilated and ischemic cardiomyopathy were considered in the differential diagnosis. The factors associated with increased risk of PPCM were age over 30 years, multiparity, preeclampsia. The clinical effect of bromocriptine confirms the diagnosis.