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Peripartum Cardiomyopathy Complicated by Preeclampsia with Mitral Stenosis

Author : T.T. Dewi, I. Rakhmawati, I. R. Hidayat, P. Aulia, D. Y. Pertiwi, D. Rostiati.
Upload Date : 19-04-2018

Background: Peripartum cardiomyopathy (ppcm) is medical emergency should immediately properly diagnosed. The condition can be exacerbated by the presence of preeclampsia. In addition, valvular heart disease that already exists can affect the patient's condition. The valvular condition which carries the highest risk in pregnancy is mitral stenosis.

Methods: Cased of peripartum cardiomyopathy with mitral stenosis have been observed.

Case: A 31-year-old woman complained of her first heart failure symptoms a day after delivering a healthy baby. The patient had been diagnosed with preeclampsia a month previously.  In physical examination she had BP 160/90 mmHg, HR 98 bpm, At this point, the patient was diagnosed peripartum cardiomyopathy, pulmonary edema, New York Heart Association functional class III heart failure and preeclampsia. Echocardiography showed global hypokinetic and LVEF 37% with mitral stenosis mild to moderate. The patient was treated with digitalis and diuretics.

Discussion: PPCM is an idiopathic cardiomyopathy circumstances, related to pregnancy, manifests as heart failure due to left ventricular systolic dysfunction, usually occurs in the first months of pregnancy up to five months postpartum. Clinical manifestation are often found when patients come is by NYHA functional class III or IV. PPCM risk factors are identified in the form of diseases that cause cardiovascular disorders, for example during pregnancy that is preeclampsia. Mitral stenosis is the most common valve abnormality in pregnant women. In mitral stenosis there is a disruption of blood flow due to changes in the structure of mitral leaflets. In this cased, the patient was treated with diuretic for reduce fluid retension and digitalis strengtens the pumping ability of the heart. ACE inhibitors are not given because they can reduce left ventricular volume in mitral stenosis.

Conclusion: Preeclampsia is a risk factor for ppcm. Ppcm with mitral stenosis is a condition that aggravate each other because both of them cause sistolic and diastolic dysfunction of the left ventricle.

KEYWORDS : ppcm, preeclampsia, mitral stenosis.

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