Peripartum cardiomyopathy (PPCM) is a rare form of pregnancy associated myocardial disease characterized by left ventricular systolic dysfunction [1]. Risk factors include multiparity, advanced maternal age, multiple pregnancies, pre-eclampsia, gestational and pre-existing hypertension and Afro-Caribbean race [2]. Nonspecific symptoms like fatigue and palpitation may present. Dyspnea and tachycardia are the most common complaints. Around a half of cases achieve spontaneous and complete recovery of left ventricular function after gestation. However，the remaining present with a much more progressive disease which may require intensive treatments and even heart transplantation [3]. Here we report a fatal case of PPCM, which was successfully managed …show more content…
Two days before admission, the woman developed progressing shortness of breath and paroxysmal nocturnal dyspnea. Primary examinations were unremarkable. However, orthopnea developed and pink frothy sputum emerged the next day. Her pulse was 140 beats per minute, oxygen saturation (SpO2) 82%, and arterial oxygen partial pressure (PaO2) 49.1 mmHg in arterial blood gas analysis test (ABG). Meanwhile, the fetal ultrasound showed single live fetus with a systolic/diastolic ratio (S/D) as high as 4.78. She was transferred by ambulance to our …show more content…
The pulse was 159 beats per minute, respiratory rate 42 breathes per minute and SpO2 65%. The chest radiograph showed an enlarged heart and bilateral pleural effusion, and ABG revealed PaO2 48 mmHg on supplemental oxygen by nasal cannula. Fetal ultrasound revealed a stillbirth concurrently. Oxygen supplement via a face mask at a flow rate of 8L/min was given. Cedilanid, torasemide, and morphine were administered intravenously to treat the heart failure. The obstetrician on call suggested that the dead fetus should be removed immediately after the patient’s vital signs were stabilized. However, the patient’s condition deteriorated progressively. The endotracheal tube was inserted and mechanical ventilation was started as a result of refractory respiratory failure which could not be improved by noninvasive ventilator support (figure 1). SpO2 increased to 90% after intubation with high levels of positive end expiratory pressure (PEEP) and a fraction of inspired oxygen (FiO2). Meanwhile, lab tests showed the pro-Brain Natriuretic Peptide (pro-BNP) 14000 pg/ml (normal range <133 pg/ml), BNP 2919.1 pg/mL (normal range: 0-87 pg/mL) and transthoracic echocardiography indicated impairment of left ventricular systolic function, with an estimated left ventricular ejection fraction (LVEF) of 40% and mild pulmonary hypertension. Discussion by the multidisciplinary team was carried out urgently. PPCM was diagnosed and