Triplet Pregnancy and Peripartum Cardiomyopathy
Zeki Yüksel Günaydın1, Selim Ekinci2, Ahmet Kaya1, Güney Erdoğan3
2Kackar State Hospital,Rize,Turkey
3Fatsa state Hospital,Ordu,Turkey
Peripartum cardiomyopathy (PPCM) is a disorder of unknown etiology in which heart failure due to left ventricular dysfunction occurs between the last month of pregnancy and first five months post-partum. In this case report,we describe the development of PPCM in a young patient with a triplet pregnancy.
A 22-year-old,primigravida, at 36 weeks of gestation was admitted to our hospital in August 2011,for delivery of triplet pregnancy.An elective cesarean section was carried out under combined spinal epidural anesthesia. Two hours later after the operation,she started to complain of progressive shortness of breath and chest discomfort.. She gave no history of any cardiac problems before. Her past medical history was otherwise unremarkable. On examination, she was pale and mildly dyspnoeic. The blood pressure was 110/70 mm Hg, the pulse was 110 beats/minute, regular, and the respiratory rate was 31/minute. The chest examination revealed significant bilateral basal crackles. The cardiovascular examination showed a raised jugular venous pressure at about 7 cm above sternal angle. The cardiac auscultation showed normal first and second heart sounds,a third heart sound with a gallop rhythm. ECG showed sinus tachycardia. Chest X-ray showed pulmonary interstitial edema and increase in cardiac silhouette.Laboratory tests revealed no proteinuria and a BNP level of 860 pg/ mL. A CT scan of the chest was negative for pulmonary emboli.An echocardiography showed diffuse hypokinesis of the left ventricle with ejection fraction of 23% and the left ventricular end-diastolic dimension was 61 mm(normal 35 to 56 mm).She was diagnosed as having peripartum cardiomyopathy and the patient was treated for congestive heart failure with furosemide,karvedilol and ramipril;40 mg/day 6.25 mg/day 2.5 mg/day respectively. She responded promptly to anti-failure therapy and was discharged after two weeks of hospitalization.On follow-up visit, the improvement was sustained and 6 months later echocardiography revealed normal left ventricular function with ejection fraction of 59%.
The etiology for PPCM is unknwon, there is much current interest in infectious, autoimmune, and genetic factors that may play a role as etiologies.Multiparity, twins, advanced maternal age (age > 30), preeclampsia, gestational hypertension, and black race have been described as risk factors for PPCM.In our case,she has triplet pregnancy associated with peripartum cardiomiyopathy and there was no data in literature about this.Especially, triplet pregnancy has greater hemodynamic perturbations, greater hormonal change, and greater demand on nutritional reserves, all of which could be involved in the pathophysiology of PPCM.
Keywords: peripartum cardiomiyopathy,triplet pregnancy