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Brain & Heart Enhancing peripartum cardiomyopathy awareness

Society of Cardiology defined PPCM as “heart failure gagging, and segmentary alterations of systolic heart
that occurs toward the end of pregnancy or in the months contraction based on an echocardiographic evaluation.
following delivery, where no other cause of heart failure A series of laboratory tests, showing high levels of liver
is found” . The prevalence of PPMC is on the rise due to enzymes and high-sensitivity cardiac troponin I (hscTnI)
[2]
two main reasons: (i) The accumulation of more advanced as well as increased flogosis indices, indicated that the
knowledge about this pathological condition, which allows patient suffered from neutrophil leukocytosis. The
better understanding and faster identification; and (ii) the electrocardiogram (ECG) showed sinus tachycardia with
growing influence or prevalence of the risk factors for diffused and a specific ventricular repolarization phase
PPCM, such as advanced maternal age, preeclampsia, and alterations. The echocardiogram documented moderate
concomitant cardiovascular risk factors . Although the left ventricular dilation (LVEDDi 3.6 cm/m ; LVEDVi
[3]
2
physiopathology of PPMC is clearly known, the precise 72 mL/m ) with severely reduced global systolic function
2
underlying mechanisms have yet to be elucidated. It is (EF 35 – 38%) related to apical, interventricular septum,
possible that the etiology of PPMC is multifactorial. One and anterior wall akinesis. Furthermore, there was minimal
of the main hypotheses links viral myocarditis to PPCM, circumferential pericardial effusion.
in which the inflammatory response might trigger the Antibiotic (metronidazole 500 mg thrice a day
biochemical pathway that leads to the occurrence of + piperacillin 13.5 g/day) and non-steroidal anti-
PPMC . However, based on our current understanding of inflammatory drug (NSAID; ibuprofen 600 mg twice
[4]
the pathological condition, the “two-hit” hypothesis, which a day) were administered to the patient when she was
associates vascular insult caused by anti-vascular factors feverish, after laboratory test results were obtained.
or hormones produced during late pregnancy and early Flogosis subsided after the treatment. To address the
postpartum period to the development cardiomyopathy cardiological issues, treatments including anticoagulant
in women with an underlying predisposition, is viewed (enoxaparin sodium 6000 UI twice a day), loop diuretics
as a more justified theory explaining the development of (60 mg/day), ramipril (5 mg/day), canrenone (50 mg/day),
PPCM . As for clinical findings, PPCM typically presents and bisoprolol (2.5 mg/day) were administered.
[1]
with heart failure symptoms, such as shortness of breath
th
on exertion, paroxysmal nocturnal dyspnea, and lower On the 5 day of hospitalization, the patient experienced
[5]
limb edema . In rare cases, the presentation may be sudden aphasia and right hemiplegia, and a modified
characterized by cardiogenic shock, requiring inotropic ECG showed giant inverted T waves in the precordial
or mechanical circulatory support, or by arrhythmias leads (Figure 1). At the same time, the echocardiogram
and thromboembolic events. Echocardiography should documented the presence of a pedunculated left ventricular
always be performed when PPCM is suspected, and the thrombus (1.5 × 4.5 cm, Figure 2). For this reason, we
main findings are left ventricular systolic dysfunction performed CT angiography of the patient’s cerebral
with ejection fraction (EF) <45%, and left and right arteries, which showed sphenoidal proximal left tract (M1
ventricular dilation with functional mitral and/or tricuspid segment) of the middle cerebral artery and carotid siphon
regurgitation . Since the occurrence of intracardiac occlusion. Within 6 h of symptom onset, stent retriever
[6]
thrombus is common, the left ventricular apex should thrombectomy was performed. Subsequent optimal
always be examined for signs of thrombosis . Considering angiographic result is shown in Figure 3. Two hours later,
[7]
the exposure to radiation during computed tomography the patient manifested complete rehabilitation with clinical
(CT) scanning and the need to avoid gadolinium exposure regression of previous neurological signs.
during pregnancy, echocardiography is considered the Due to the diagnosis with pedunculated left
most appropriate imaging method for detecting PPCM. endoventricular thrombus having a small implantation
Endomyocardial biopsy is required when another base, which can heighten the risk of new embolization,
pathological condition, such as giant cell myocarditis, is the patient was not prescribed another session of
suspected, since it needs to be managed with a different anticoagulant therapy as it could further increase the
therapy. In the process of diagnosing PPCM, any possible risk of microembolization. Instead, surgical cardiac
pre-existing heart muscle diseases or valvular pathologies thrombectomy was performed on the patient. At the
must be excluded to avoid misdiagnosis . time of pericardial exposure, the heart appeared small
[6]
and noticeably hyperkinetic. During the extracorporeal
2. Case presentation circulation and after having localized the thrombus through
A 32-year-old female was transferred from the Gynecology high-resolution epicardial echocardiography, a small
and Obstetrics Department 2 days after undergoing an apical incision was performed to remove the thrombotic
eutocic delivery, as she presented with shivering fever, mass, which appeared to possess a pedunculated root

Volume 1 Issue 2 (2023) 2 https://doi.org/10.36922/bh.1115