Peripartum Cardiomyopathy Presenting at Cesarean Delivery

Malinow, Andrew M.; Butterworth, John F.; Johnson, Mark D.; Safon, Leonard E.; Rein, Mitchell S.; Hartwell, B L; Datta, Sanjay; Lind, Leonard J.; Ostheimer, Gerard W.

doi:10.1097/00132582-198606000-00024

Cited by 11 publications

(49 citation statements)

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“…Malinow presented two patients undergoing CS under spinal anesthesia and general anesthesia (GA) respectively. 8 Both had full cardiac recovery within seven to eight days. Epidural lidocaine, titrated in small aliquots together with fentanyl, has been successfully employed in a patient with pulmonary hypertension and cardiomyopathy.…”

Section: Discussionmentioning

confidence: 97%

Combined spinal-epidural anesthesia for Cesarean section in a patient with peripartum dilated cardiomyopathy

Shnaider¹,

Ezri²,

Szmuk³

et al. 2001

Can J Anesth/J Can Anesth

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Purpose: To report a case of peripartum dilated cardiomyopathy associated with morbid obesity and possible difficult airway presenting for elective Cesarean section, which was successfully managed with combined spinal-epidural anesthesia.Clinical features: A morbidly obese parturient with a potentially difficult airway, suffering from idiopathic peripartum cardiomyopathy (ejection fraction 20%), was scheduled for an elective Cesarean section.A combined spinal epidural anesthesia was performed and 6 mg of bupivacaine were injected into the subarachnoid space. This was supplemented after 60 min with 25 mg of bupivacaine injected epidurally. The patient's hemodynamic status was monitored with direct intra-arterial blood pressure and central venous pressure measurements. The patient's perioperative course was uneventful. Conclusion:In patients suffering from peripartum cardiomyopathy, undergoing Cesarean section, combined spinal-epidural anesthesia may be an acceptable anesthetic alternative. ERIPARTUM cardiomyopathy occurs in approximately 1/10,000 deliveries 1 and can result in severe ventricular dysfunction during late pregnancy or early puerperium. 2 We present a patient with peripartum cardiomyopathy requiring Cesarean section (CS) who was managed with combined spinal-epidural (CSE) anesthesia.Case report A 25-yr-old, morbidly obese (weight 100 kg, height 1.58 m and body mass index 40) primigravida at 36 weeks gestation, with a Mallampati class IV airway, was scheduled for an elective CS. Two weeks before, she had complained of progressively worsening fatigue and dyspnea with minimal physical activity. A cardiology consultation obtained to evaluate progressively worsening fatigue led to the diagnosis of idiopathic dilated cardiomyopathy. Echocardiography revealed severe left ventricular dysfunction ejection fraction (EF) 20% with moderate pulmonary hypertension and moderate right ventricular dysfunction. Treatment with furosemide, digoxin, and potassium supplemen-OBSTETRICAL AND PEDIATRIC ANESTHESIA

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Section: Discussionmentioning

confidence: 97%

Combined spinal-epidural anesthesia for Cesarean section in a patient with peripartum dilated cardiomyopathy

Shnaider¹,

Ezri²,

Szmuk³

et al. 2001

Can J Anesth/J Can Anesth

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“…3,4 Graded epidural anaesthesia has been mostly used because of its better hemodynamic stability. 5,6 Bilenjani et al described caesarean section in a 19-yearold patient at 32 weeks of gestation with PPCM in decompensated heart failure and pulmonary edema. GA was induced with etomidate and remifentanil, and maintained with remifentanil infusion safely, without any adverse outcome on mother or newborn.…”

Section: Discussionmentioning

confidence: 99%

“…It also facilitates the use of transesophageal echocardiography. 6 But GA also has several disadvantages like maternal and fetal cardiorespiratory depression, cardiac arrest due to severe bradycardia, increased risk of left ventricular failure and pulmonary edema. It carries a higher risk of thromboembolism than RA in these patients.…”

Section: Journal Of Society Of Anesthesiologists Of Nepalmentioning

confidence: 99%

Anaesthetic management of emergency caesarean section in a patient with peripartum cardiomyopathy under general anaesthesia - a case report

Raj

Priti

Quari

2016

J. Soc. Anesth. Nep.

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Peripartum cardiomyopathy is a unique and rare kind of cardiomyopathy of unknown cause that occurs during pregnancy or the postpartum period. Regional anaesthesia for anaesthetic management of this condition has been extensively described. There are limited reports of anaesthetic management of caesarean section of this case under general anaesthesia. We report a case of 32 years old lady diagnosed to have peripartum cardiomyopathy requiring emergency caesarean section that was successfully managed under general anaesthesia. Anaesthetic management was directed towards optimization of myocardial contractility, preload and after load.

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“…It is a form of reversible cardiomyopathy mimicking acute myocardial infarction in both symptomatology and ECG findings, but without significant coronary artery disease on angiography [10] . The condition is typically seen in postmenopausal women, suggesting a protective effect of estrogens, but TCM in pregnant women has also been described in the peripartum period irrespective of mode of delivery [11,12] . Very recently, Zdanowicz et al [13] reported a case of a young woman undergoing elective cesarean section with apparent symptoms of acute coronary syndrome who was later diagnosed with TCM.…”

Section: Discussionmentioning

confidence: 99%

Ventricular fibrillation as primary presentation of takotsubo cardiomyopathy after complicated cesarean delivery

Bortnik¹

2012

WJC

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Takotsubo cardiomyopathy typically affects post-menopausal women under severe psychological or physical stress; it also has been reported to develop after medical procedures or surgery. We herein report the rare case of a 30-year-old woman who presented with an episode of ventricular fibrillation after a very complicated cesarean delivery and was successfully resuscitated. Subsequent electrocardiography and echocardiography showed a typical Takotsubo pattern. Within 3 wk, left ventricular systolic function returned to normal.

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Peripartum Cardiomyopathy Presenting at Cesarean Delivery

Cited by 11 publications

References 0 publications

Combined spinal-epidural anesthesia for Cesarean section in a patient with peripartum dilated cardiomyopathy

Combined spinal-epidural anesthesia for Cesarean section in a patient with peripartum dilated cardiomyopathy

Anaesthetic management of emergency caesarean section in a patient with peripartum cardiomyopathy under general anaesthesia - a case report

Ventricular fibrillation as primary presentation of takotsubo cardiomyopathy after complicated cesarean delivery

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