Takotsubo cardiomyopathy is a rare syndrome characterized by acute left ventricular dysfunction with regional left ventricular ballooning, mimicking myocardial infarction. This condition is often described in post-menopausal women. Authors present a case in an elderly primi with twin gestation immediately after Cesarean surgery. We discussed her presentation, investigations, diagnosis, management and outcome. 35 year female, a primi with twin pregnancy developed chest pain and shortness of breath immediately after Cesarean surgery. Her Electrocardiograph was abnormal, and Echocardiogram demonstrated abnormal apical ballooning of the left ventricle and severe dysfunction. Cardiac enzymes were elevated and chest skiagram showed pulmonary edema. She was managed in the intensive care unit with oxygen supplementation, diuretics and inotropes. She made an excellent recovery with normalization of left ventricular ejection fraction within 8 days. During the six months follow up, she was asymptomatic and left ventricular function remained normal.
Diagnosing the aetiology of jaundice is extremely important in pregnant patients as certain conditions like Acute fatty liver of pregnancy (AFLP), HELLP syndrome and intra-hepatic cholestasis of pregnancy (ICP) may require early termination of pregnancy even in the presence of jaundice and or coagulation failure. Once diagnosed, prompt delivery is associated with a significantly improved outcome. A 20 years old primigravida patient with 34 weeks pregnancy presented to outpatient department of obstetrics and gynecology department of SBH Government Medical College, Dhule, with nausea, vomiting, jaundice, ascites and coagulopathy. The patient was subjected to detailed work-up including laboratory investigations and radiological examinations. A diagnosis of acute fatty liver of pregnancy was made based on the Swansea criteria. The labour was induced with delivery of live male fetus of 2.1 kg in good condition. The case of AFLP was managed using supportive treatment in intensive care unit with blood products, careful fluid management and prevention of hypoglycaemia. Careful history and physical examination in conjunction with compatible laboratory and imaging results are often sufficient to make the diagnosis and liver biopsy is rarely indicated.
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