Unknown Rheumatic Cardiac Disease as Cause of Acute Onset Post-Partum Dyspnea: a Case Report

Abstract

Background: Acute post-partum dyspnea configures an obstetric challenge with multiple differential diagnosis. Case Presentation: We present a case of a previous healthy woman with preeclampsia who developed severe dyspnea 30 hours after delivery. She complained of cough, orthopnea, and bilateral lower extremities oedema. She denied headaches, blurry vision, nausea, vomiting, fever or chills. Auscultation revealed a diastolic murmur, and was compatible with pulmonary oedema. A timely bedside echocardiogram showed moderate dilated left atrium with severe mitral insufficiency suggestive of an unknown rheumatic disease. She was managed with noninvasive ventilation, loop diuretics, vasodilators, thromboprophylaxis, head-end elevation, and fluid restriction with progressive improving. Conclusions: Previously silent cardiac diseases constitute intriguing causes of post-partum dyspnea with pulmonary oedema. A timely and multidisciplinary approach is required to manage these situations.