Peripartum Cardiomyopathy Complicated by Ventricular Tachycardia during Labor: A Case Report and Literature Review

Background: Peripartum cardiomyopathy (PPCM) is a rare disease that typically affects young, healthy women. Because PPCM is associated with significant mortality, timely diagnosis and management are essential. Ventricular tachycardia (VT) is a major complication and contributor to sudden death. Available data on VT in patients with PPCM are limited. Aim: This case report demonstrates the clinical presentation, antenatal care, and management of labor and delivery in a patient with PPCM complicated by VT. Case report: 36-year old patient G4P3 presents at 27 weeks gestation to the emergency department complaining of chest tightness, palpitations, and profuse sweating. Peripartum cardiomyopathy was diagnosed after her last pregnancy a few years prior. Ventricular tachycardia was diagnosed at this visit and treated successfully. The remainder of the pregnancy was uneventful until she had another episode of ventricular tachycardia during labor. Treatment using antiarrhythmics (diltiazem, amiodarone, adenosine) highlights the importance of prompt intervention and the need for a range of therapeutic options. Results: This case demonstrated successful VT management during pregnancy and labor, emphasizing multidisciplinary collaboration, influencing maternal and fetal outcomes positively, providing insights into optimal care strategies. Conclusion: Peripartum cardiomyopathy complicated by ventricular tachycardia is a life-threatening combination. This case highlights the importance of timely diagnosis and management with combined care between cardiologists, maternal fetal medicine specialists and anesthesiologists to prevent morbidities and sudden maternal death.

Clinical Management and Long-Term Follow-Up of Patients with Peripartum Cardiomyopathy: A Prospective Registry Study

Introduction: Peripartum cardiomyopathy (PPCM) is a rare pathology in Western countries but is common in Africa. Its progression is highly variable, left ventricular function improves in almost one-third to one-half of patients. In sub-Saharan Africa, there are few prospective cohort studies. We aimed to describe the long-term evolutionary aspects of this pathology in a sub-Saharan African country, so we developed a PPCM registry;here, we present the first results after 2 years of follow-up. Methodology: This work was performed at the cardiology clinic of the Aristide Le Dantec Teaching Hospital of Dakar from January 01, 2017, to January 01, 2021, for a total duration of 4 years. This was an observational, longitudinal prospective study including patients admitted for peripartum cardiomyopathy. Results: During our study, 5372 patients were admitted to the cardiology clinic. Considering the inclusion criteria, 79 patients were consecutively recruited. The mean age was 30.5 ± 6.7 years, ranging from 18 to 42 years. Half of the patients came from rural areas (56.3%), and 78.2% of patients had a low socioeconomic status. Multiparity and twin pregnancies were noted in 72.8% and 20% of the patients, respectively. A total of 91% of patients had advanced NYHA stage 4 heart failure, and 3 patients had cardiogenic shock. Left ventricular dilatation was found in 52 patients, and severe left ventricular systolic dysfunction was found in 50 patients (90.9%). During hospitalization, 19 patients (34.5%) had complications. The evolution in the hospital was favourable in 45 patients (81.8%). The global mortality rate was 7.3% at 2 years. In multivariate analysis, fewer patients with a dilated left ventricle, a severe alteration of the LVEF and an advanced age progressed towards remission. Conclusion: The long-term evolution of PPCM is very variable. Despite a good rate of remission, progression to end-stage heart failure and death is not negligible in cases of advanced maternal age and severe left ventricular impairment.

Effect of inflammation and autoimmunity in peripartum cardiomyopathy

Objective To explore the effect of inflammation and autoimmunity in peripartum cardiomyopathy （PPCM）. Methods A total of 82 PPCM patients and 100 normal delivery patients were randomly selected and conducted epidemiological survey. High-sensitivity C- reaction protein （hs-CRP）, troponin I, human antimyocardial antibody IgG （AMA-IgG）, Coxsackie B virus IgG （CBV-IgG） and adenovirus antibody IgG （ADV- IgG） were detected with ELISA. Results Compared with control group, PPCM patients had older age, higher pressure, higher proportion of cesarean section and infection. The levels of serum hs-CRP, cTNI, and leucocyte were markedly higher in PPCM patients compared with control. The positive proportion of AMA-IgG and CBV-IgG was signifi- cantly increased （P〈0.01） in PPCM patients compared with the control. Logistic regression showed that infection （OR=2.87, 95%CI 1.15-5.24）, increased hs-CRP （OR=1.86, 95%CI 1.08-4.02） and positive AMA-IgG （OR=2.68, 95%CI 1.19-4.85） were independent risk factors for PPCM. Conclusions Inflammation and autoimmunity play an important role in peripartum cardiomyopathy（J Geriatr Cardio12010; 7：106-109）.

PERIPARTUM CARDIOMYOPATHY——REPORT OF 16 CASES

Objective.To analyze the clinical characteris tics of peripartum cardiomyopathy a nd to evaluate the different factors that influence the prognosis of the peripartum cardiomyopathy.Method.A retrospective review was undertak en on records of women who were diagnosed with peripartum cardiomyopathy at Peking Union Medi cal College Hospital between Jan.1983and May 1999.Results.During the research period,only 16p regnant women were documented as peripartum cardiomyopa-thy.Some of the women undertook ultr asonic cardiographic(UCG)examination that showed decreased s ystolic function.Seven women were complica ted with pregnancy induced hyperten sion.Three died of disseminated intravascular coagulation,embolism and cardiogenic shock respectively.Conclusion.Early diagnosis of the peripartum ca rdiomyopathy is extremely important.The UCG can pro-vide helpful information on disease progression or regression.

Cardiomyopathies in Tropical Countries:Causes and Nosological Perspective

Background: Cardiomyopathy is the main cause of heart failure in developing countries, mainly in Africa. In those areas the concept of “tropical cardiomyopathy” is still used to design all unexplained cardiomyopathy. The primary aim of this review is first to review the main etiologies of cardiomyopathies observed in tropical countries and second to gain a better understanding of the nosological place of the so-called “tropical cardiomyopathies” in the current framework of cardiomyopathies. Methods and Results: We reviewed relevant references over the last forty years (June, 1976 to May 2012). Given literature data, endomyocardial fibrosis (EMF) is mainly diagnosed in sub-Saharan countries, as well as Brazil and India. Peripartum cardiomyopathy (PPCM) is observed with a higher prevalence than in temperate countries. Sickle cell anemia does not induce specific cardiomyopathy in all echocardiographic studies. Malnutrition and chronic anemia can induce reversible cardiac dysfunction. Myocardial involvement in parasitic infections is restricted to Chagas disease and probably to human African trypanosomiasis. Helminthiasis is not involved in the pathogenesis of cardiomyopathy except for the deleterious effect of high eosinophilia induced by some endemic diseases (filariasis, schistosomiasis). Primary cardiomyopathies (dilated, hypertrophic, and restrictive cardiomyopathy) have no specificity. Arrhythmogenic right ventricular dysplasia and left ventricular noncompaction are also reported and do not differ from elsewhere. Conclusions: The concept of tropical cardiomyopathy is no longer relevant as most of the cardiomyopathies observed in tropical countries have no specificity, with few exceptions (PPCM, EMF, Chagas disease). In this context, the European Society of Cardiology classification offers a simpler clinical approach and allows the inclusion of the rare tropical specificities.

The role of temporary mechanical circulatory support in de novo heart failure syndromes with cardiogenic shock:A contemporary review

Cardiogenic shock(CS)is a complex clinical syndrome with a high mortality rate.It can occur to due to multiple etiologies of cardiovascular disease and is phenotypically heterogeneous.Acute myocardial infarction-related CS(AMI-CS)has historically been the most prevalent cause,and thus,research and guidance have focused primarily on this.Recent data suggest that the burden of non-ischemic CS is increasing in the population of patents requiring intensive care admission.There is,however,a paucity of data and guidelines to inform the management of these patients who fall into two broad groups:those with existing heart failure and CS and those with no known history of heart failure who present with"de novo"CS.The use of temporary mechanical circulatory support(MCS)has expanded across all etiologies,despite its high cost,resource intensity,complication rates,and lack of high-quality outcome data.Herein,we discuss the currently available evidence on the role of MCS in the management of patients with de novo CS to include fulminant myocarditis,right ventricular(RV)failure,Takotsubo syndrome,post-partum cardiomyopathy,and CS due to valve lesions and other cardiomyopathies.