Therapeutic options for patients diagnosted with peripartum cardiomyopathy

Introduction: Peripartum cardiomyopathy is one of the complications that may occur during pregnancy or post-partum. It is defined by the association between left systolic dysfunction, no history of cardiovascular diseases and specific onset within 1 month before birth and 5 months thereafter. Many studies show that the-re are various etiologic and predisposing factors such as mother’s age, infections, malnutrition or prolonged tocolysis. In these cases, the optimal management re-quires the set up of a multidisciplinary in-hospital team in order to choose the therapeutic strategy with maxi-mum benefit for both mother and baby.

Methods: We present the case of a 49-year-old woman with a first pregnancy at the age of 41, smoker and wi-thout known diseases, who is diagnosed with peripar-tum cardiomyopathy with severe systolic dysfunction, paroxysmal atrial fibrillation and nonsustained ven-tricular tachycardia for which a cardiac defibrillator was implanted and with multiple hospitalizations for decompensated heart over the last 3 years. The patient is hospitalized in our clinic for heart failure signs and symptoms

Results: Clinical examination – tachycardia, holosysto-lic murmur best heard at the left lower sternal border, hepatomegaly and anasarca. Biohumoral – iron-defici-ency anemia, cholestasis and hepatic cytolysis and mo-dified plasma ions. Echocardiography – circumferential pericardial effusion (surrounds the posterior portion of the heart) 12 mm, left ventricle with diffuse hypo-kinesis (ejection fraction 20%) and spontaneous echo-cardiographic contrast, akinesis of the interventricular septum and severe tricuspid regurgitation. The patient started treatment with Sacubitril/Valsartan 49/51 mg x2 daily, but due to orthostatic hypotension the dose was reduced to 24/25 mg x2 daily. Ivabradine 5 mg x2 daily was also added, and during the period of hospi-talization a reduction of heart rate and a weight loss of approximately 13 kg was achieved. At the one month follow-up the symptoms have improved, peripheral edema disappeared and the ejection fraction increased to 25-30%.

Conclusions: Peripartum cardiomyopathy has a vari-able evolution and recurrences are possible during fu-ture pregnancies. The particularity of this case is the improvement of symptoms, clinical signs and echocar-diographic parameters only one month after treatment adjustment in the case of a patient with associated risk factors for peripartum cardiomyopathy. Medication adherence and a strict hygiene and diet plan are the premises of an appropriate management of these cases with important implications for both long and short prognosis.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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