Peripartum cardiomyopathy and acute heart failure associated with prolonged tocolytic therapy in pregnancy

Abstract

Rationale: Peripartum cardiomyopathy (PPCM) is a rare and sometimes fatal systolic heart failure that affects women during late pregnancy or the early postpartum period. Heart failure symptoms can mimic the physiological changes of normal pregnancy, and the diagnosis is based on echocardiography. Patient concerns: A 38-year-old multiparous woman with a history of cervical incompetence underwent cervical cerclage and received tocolysis for 100 days. Diagnoses: She delivered vaginally at 37 weeks of gestation but developed postpartum decompensated acute heart failure with low left ventricular ejection fraction (LVEF: 34%) and was diagnosed with PPCM. Interventions: She received standard therapy for acute heart failure. Outcomes: The patient's pulmonary edema cleared, and she was fully ambulatory 6 days after admission. A follow-up echocardiogram 3 months later demonstrated recovery of LVEF to 66%. Lessons: Prolonged tocolysis may contribute to cardiomyopathy and should be used with caution. PPCM management requires standard treatments for acute heart failure with modifications for fetal safety.

Peripartum Cardiomyopathy Due to Gestational Hypertension and Tocolytic Therapy

“…They cause decreased baroreflex sensitivity that leads to dysregulation of vagal heart rate and increased blood pressure variation. In addition, their beta agonistic effect is potentially cardiotoxic [6].…”

“…The risk factors contributing to this condition are advanced maternal age, multiparity, administration of tocolytic agents, underlying cardiac disease, iatrogenic volume overload, preeclampsia, and hypertension. In patients with gestational hypertension (GH) and other risk factors, close monitoring is mandatory during pregnancy as well as in the postpartum period [4], [5], [6].…”

Peripartum Cardiomyopathy Due to Gestational Hypertension and Tocolytic Therapy

“…What should be noted is that the patient had polyuria here first 3 days with diuresis reaching up to 10 liters per day, demonstrating the high volume overload she had. The potassium level was normal on the fourth day of admission [4][5][6].…”