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Pubblicazioni recenti - peripartum cardiomyopathy
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Outcome in German and South African peripartum cardiomyopathy cohorts associates with medical therapy and fibrosis markers.
ESC Heart Fail2020 Feb;():. doi: 10.1002/ehf2.12553.
Azibani Feriel, Pfeffer Tobias J, Ricke-Hoch Melanie, Dowling Wentzel, Pietzsch Stefan, Briton Olivia, Baard Johann, Abou Moulig Valeska, König Tobias, Berliner Dominik, Libhaber Elena, Schlothauer Stella, Anthony John, Lichtinghagen Ralf, Bauersachs Johann, Sliwa Karen, Hilfiker-Kleiner Denise,
Abstract
AIMS:
This study aims to compare the clinical course of peripartum cardiomyopathy (PPCM) cohorts from Germany (G-PPCM) and South Africa (SA-PPCM) with fibrosis-related markers to get insights into novel pathomechanisms of PPCM.
METHODS AND RESULTS:
G-PPCM (n = 79) and SA-PPCM (n = 72) patients and healthy pregnancy-matched women from Germany (n = 56) and South Africa (n = 40) were enrolled. Circulating levels of procollagen type-I (PINP) and type-III (PIIINP) N-terminal propeptides, soluble ST2, galectin-3, and full-length and cleaved osteopontin (OPN) were measured at diagnosis (baseline) and 6 months of follow-up. Both cohorts received standard heart failure therapy while anticoagulation therapy was applied in 100% of G-PPCM but only in 7% of SA-PPCM patients. In G-PPCM patients, baseline left ventricular ejection fraction (LVEF) was lower, and outcome was better (baseline LVEF, 24 ± 8%, full recovery: 52%, mortality: 0%) compared with SA-PPCM patients (baseline LVEF: 30 ± 9%, full recovery: 32%, mortality: 11%; P < 0.05). At baseline, PINP/PIIINP ratio was lower in SA-PPCM and higher in G-PPCM compared with respective controls, whereas total OPN was elevated in both collectives. Cleaved OPN, which increases PIIINP levels, is generated by thrombin and was reduced in patients receiving anticoagulation therapy. High baseline galectin-3, soluble ST2, and OPN levels were associated with poor outcome in all PPCM patients.
CONCLUSIONS:
SA-PPCM patients displayed a more profibrotic biomarker profile, which was associated with a less favourable outcome despite better cardiac function at baseline, compared with G-PPCM patients. Use of bromocriptine and anticoagulation therapy in G-PPCM may counteract fibrosis and may in part be responsible for their better outcome.
© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.
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Promoting awareness of peripartum cardiomyopathy (PPCM).
Int J Cardiol -
Bromocriptine use for sudden peripartum cardiomyopathy in a patient with preeclampsia: a case report.
JA Clin Rep2019 Jun;5(1):38. doi: 10.1186/s40981-019-0256-8.
Hakata Saya, Umegaki Takeshi, Soeda Takehiro, Nishimoto Kota, Ando Akiko, Anada Natsuki, Uba Takeo, Sumi Chisato, Kamibayashi Takahiko,
Abstract
BACKGROUND:
Peripartum cardiomyopathy is an uncommon form of heart failure that occurs in otherwise healthy women during pregnancy or until 5 months postpartum. Here, we report a rare case where a female patient underwent cesarean section after the occurrence of preeclampsia and intrauterine fetal death, and developed peripartum cardiomyopathy following postsurgical respiratory distress. The prompt initiation of inotropic drug and bromocriptine therapy quickly restored cardiac function.
CASE PRESENTATION:
The patient was a 36-year-old woman who underwent emergency cesarean section for a previous preeclampsia and an intrauterine fetal death that occurred after 24 weeks of pregnancy. In addition, the patient had an extremely low platelet count of 5000/?L on admission. She had been diagnosed as idiopathic thrombocytopenic purpura at the age of 29?years old and treated with prednisolone at 15?mg/day. Therefore, the cesarean section was performed under general anesthesia. The patient did not exhibit respiratory or hemodynamic dysfunction during surgery. However, she developed respiratory distress with sinus tachycardia after extubation and was transferred to the intensive care unit. A chest radiograph showed butterfly shadows, and transthoracic echocardiogram confirmed the reduction of left ventricle contractility (ejection fraction 20%). She was diagnosed with peripartum cardiomyopathy and treated immediately with intravenous milrinone, oral bromocriptine, and angiotensin-converting enzyme inhibitor. Respiratory and hemodynamic function improved rapidly, and the patient was moved to the general ward 2?days after surgery. Fourteen days after surgery, the patient had an ejection fraction of 57%. The patient recovered without any further complications and was discharged 24?days after surgery.
CONCLUSION:
A sudden case of peripartum cardiomyopathy was successfully managed by a prompt diagnosis and treatment with inotropic agents and bromocriptine.
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Peripartum Cardiomyopathy Incidence, Risk Factors, Diagnostic Criteria, Pathophysiology and Treatment Options.
Cardiol Rev2020 Jan;():. doi: 10.1097/CRD.0000000000000249.
Zagelbaum Nicole K, Bhinder Jasjit, Gupta Chhaya Aggarwal, Frishman William H, Aronow Wilbert S,
Abstract
Peripartum cardiomyopathy (PPCM) is a rare and a severe form of heart failure that affects women during pregnancy or shortly after delivery. Risk factors include advanced age, race, multi-parity, multifetal pregnancy, socioeconomic disparity, and medical comorbidities including systemic hypertension, diabetes, asthma, and anemia. PPCM is associated with increased morbidity and mortality, as well as a detrimental long-term impact on quality of life. Its etiology is not clear, although it is thought to be a combined effect of a hyperdynamic fluid state associated with pregnancy, hormonal changes unique to gestation, and a genetic predisposition. There is no current expert consensus on an optimal treatment regimen. This article will provide a comprehensive review and update on this important disease state.
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Cardio-obstetrics: Recognizing and managing cardiovascular complications of pregnancy.
Cleve Clin J Med2020 Jan;87(1):43-52. doi: 10.3949/ccjm.87a.18137.
Shapero Kayle S, Desai Nihar R, Elder Robert W, Lipkind Heather S, Chou Josephine C, Spatz Erica S,
Abstract
Pregnancy can exacerbate known cardiovascular disorders and unmask previously unrecognized problems. Patients with congenital heart disorders, valvular disease, primary pulmonary hypertension, hypertensive disorders of pregnancy, and acquired peripartum cardiomyopathy need a collaborative interdisciplinary team that includes a cardiologist with specialty training in obstetrics.
Copyright © 2020 The Cleveland Clinic Foundation. All Rights Reserved.
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Incidence, clinical characteristics, and risk factors of peripartum cardiomyopathy in Nigeria: results from the PEACE Registry.
ESC Heart Fail2020 Jan;():. doi: 10.1002/ehf2.12562.
Karaye K M, Ishaq N A, Sa'idu H, Balarabe S A, Talle M A, Isa M S, Adamu U G, Umar H, Okolie H I, Shehu M N, Mohammed I Y, Sanni B, Ogah O S, Oboirien I, Umuerri E M, Mankwe A C, Shidali V Y, Njoku P, Dodiyi-Manuel S, Shogade T T, Olunuga T, Ojji D, Josephs V, Mbakwem A C, Tukur J, Isezuo S A, ,
Abstract
AIMS:
The aim of this study was to describe the incidence, clinical characteristics and risk factors of peripartum cardiomyopathy (PPCM) in Nigeria.
METHODS AND RESULTS:
The study was conducted in 22 hospitals in Nigeria, and PPCM patients were consecutively recruited between June 2017 and March 2018. To determine factors associated with PPCM, the patients were compared with apparently healthy women who recently delivered, as controls. Four hundred six patients were compared with 99 controls. The incidence and disease burden (based on the rate of consecutive recruitment of subjects) varied widely between the six geographical zones of Nigeria. From the North-West zone, 72.3% of the patients was recruited, where an incidence as high as 1 per 96 live births was obtained in a centre, while the disease was uncommon (7.6% of all recruited patients) in the South. Majority of the patients (76.6%) and controls (74.8%) (p = 0.694) were of Hausa-Fulani ethnic group. Atrial fibrillation, intracardiac thrombus, stroke, and right ventricular systolic dysfunction were found in 1.7%, 6.4%, 2.2%, and 54.9% of the patients, respectively. Lack of formal education (odds ratio [OR] 3.08, 95% confidence interval [1.71, 5.53]; P < 0.001), unemployment (OR: 3.28 [2.05, 5.24]; P < 0.001), underweight (OR: 13.43 [4.17, 43.21]; P < 0.001) and history of pre-eclampsia (OR: 9.01 [2.18, 37.75]; P = 0.002) emerged as independent PPCM risk factors using regression models. Customary hot baths (OR: 1.24 [0.80, 1.93]; P = 0.344), pap enriched with dried lake salt (OR: 1.20 [0.74, 1.94]; P = 0.451), and Hausa-Fulani ethnicity (OR: 1.11 [0.67, 1.84]; P = 0.698) did not achieve significance as PPCM risk factors.
CONCLUSIONS:
In Nigeria, the burden of PPCM was greatest in the North-West zone, which has the highest known incidence. PPCM was predicted by sociodemographic factors and pre-eclampsia, which should be considered in its control at population level. Postpartum customary birth practices and Hausa-Fulani ethnicity were not associated with PPCM in Nigeria.
© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.
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[Peripartum cardimyopathy - risk of delayed diagnosis].
Lakartidningen2020 01;117():. doi: FSS7.
Stumpf Tamás, Mattsson Gustav, Magnusson Peter,
Abstract
Peripartum cardiomyopathy is defined as heart failure, with ejection fraction less than 45% that presents late during pregnancy or the first five months postpartum. Despite being described first in 1849 by Ritchie the mechanisms behind the disease are still not fully understood. However, oxidative stress during pregnancy and the cleavage of prolactine into its 16 kDa fragment appears to play a role in the pathophysiology of peripartum cardiomyopathy. In addition to optimal therapy for heart failure bromocriptine, an inhibitor of prolactine release, should be considered. Prevalence and prognosis varies geographically. Most often left ventricular ejection fraction is normalized after six months but sometimes the disease is associated with deteriorating heart failure and death. Therefore it is important for health care professionals caring for women in the peripartum period to be aware of the signs and symptoms of the diagnosis.
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Extracorporeal Membrane Oxygenation as Salvage Therapy in the Peripartum Period: A Case Series.
ASAIO J2020 Jan;():. doi: 10.1097/MAT.0000000000001120.
Patel Sameer, Loveridge Robert, Willars Chris, Vercueil Andre, Best Thomas, Auzinger Georg,
Abstract
Despite considerable advances in maternity care, maternal death rates remain unacceptably high. Even with optimal care, unexpected complications can result in catastrophic consequences. Hemorrhage, cardiovascular and coronary conditions, and cardiomyopathy make up the three most common causes of pregnancy-associated deaths, followed by sepsis and thromboembolic disease. Although a number of deaths may be deemed to be potentially avoidable with appropriate education and infrastructure, others such as refractory hypoxia and peripartum cardiomyopathy are not. All possible interventions should be explored, including the use of more novel and aggressive life support technologies, such as extracorporeal membrane oxygenation. We report the successful use of extracorporeal membrane oxygenation in three cases of severe peripartum morbidity. The first case describes spontaneous coronary artery dissection supported with veno-arterial extracorporeal membrane oxygenation for refractory cardiogenic shock after out-of-hospital cardiac arrest. The second is a case of severe pregnancy-related liver disease bridged to emergency liver transplantation with veno-venous extracorporeal membrane oxygenation. Finally, we report the use of extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest in a postpartum patient. Peripartum extracorporeal membrane oxygenation is feasible in carefully selected patients, and should be considered early when conventional therapy is failing, or as a salvage rescue therapy when it has failed.
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Peripartum Cardiomyopathy: JACC State-of-the-Art Review.
J Am Coll Cardiol2020 Jan;75(2):207-221. doi: S0735-1097(19)38457-8.
Davis Melinda B, Arany Zolt, McNamara Dennis M, Goland Sorel, Elkayam Uri,
Abstract
Peripartum cardiomyopathy is a form of systolic heart failure affecting young women toward the end of pregnancy or in the months following delivery. Incidence is higher in African-American women and in women with older maternal age, hypertensive disorders of pregnancy, and multiple gestation pregnancies. Symptoms of heart failure mimic those of normal pregnancy, often resulting in a delay in diagnosis and preventable complications. Echocardiography showing decreased myocardial function is essential for the diagnosis. Medical management is similar to heart failure with reduced ejection fraction of other etiologies, but adjustments during pregnancy are necessary to ensure fetal safety. Variable outcomes include complete recovery, persistent heart failure, arrhythmias, thromboembolic events, and death. Subsequent pregnancy confers substantial risk of relapse and even death if there is incomplete myocardial recovery. Additional research about the etiology, optimal therapy including the use of bromocriptine, long-term outcomes, and duration of treatment after recovery are needed.
Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Bidirectional Ventricular Tachycardia in a Women with Dilated Cardiomyopathy: A Case Report.
Adv J Emerg Med2020 ;4(1):e12. doi: 10.22114/ajem.v0i0.287.
Norwood Dalton Argean, Dominguez Lucia Belem, Dominguez Ricardo Leonel, Winders Walter Tyler,
Abstract
Introduction:
Bidirectional ventricular tachycardia (BVT) is a rare arrhythmia characterized by QRS complexes with an axis in the frontal plane alternating polarity in the precordial leads and right bundle branch block (RBBB) morphology. To the best of our knowledge, there is no previous report in dilated cardiomyopathy or in the context of a probable peripartum cardiomyopathy.
Case Presentation:
A 26-year-old, 9-month female patient, with no significant past medical history (the patient denies medication intake, herbs like aconite, trouble during delivery, any heart issues or family history of sudden death or cardiomyopathies) who presents to the emergency room due to 11 days of dyspnea, exacerbated by daily activities, orthopnea, and paroxysmal nocturnal dyspnea. She presented with ventricular bigeminy and systolic dysfunction with left ventricular ejection fraction (LVEF) <20%. The patient later developed a stable ventricular tachycardia (VT) treated with amiodarone, which resulted in hemodynamic instability and BVT rhythm with VT paroxysms. Without the possibility of ablation, the use of high dose beta blockers and an implantable cardioverter defibrillator resulted in the same rhythm with a lower heart rate, better NYHA functional class, and less episodes of VTs.
Conclusion:
BVT is a rare type of tachycardia that can be present in dilated cardiomyopathy. In the absence of ablation capabilities, decreasing the heart rate with beta-blockers may reduce the rate of paroxysmal VTs.
© 2020 Tehran University of Medical Sciences.
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Peripartum Cardiomyopathy During Puerperium Co-existing with Pre-eclampsia and Complicated by Acute Renal Failure: A Case Report.
Cureus2019 Dec;11(12):e6319. doi: 10.7759/cureus.6319.
Akbar Arshia, Ata Ur-Rehman Hafiz Muhammad, Tameez Ud Din Asim, Malik Aimen,
Abstract
We report a case of peripartum cardiomyopathy (PPCM), which presented with antenatal pre-eclampsia complicated by acute kidney injury (AKI). A 25-year-old patient in her 27 week of gestation presented with high blood pressure. She was later diagnosed with PPCM, which was complicated by AKI. Our case report indicated PPCM presentation during the prepartum period, which is a rare entity. On her fifth day of admission, our patient had spontaneous expulsion of her neonate, who was found to be dead on antenatal ultrasound.
Copyright © 2019, Akbar et al.
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A case of severe peripartum cardiomyopathy requiring left ventricular assist device implantation despite the absence of late gadolinium enhancement on cardiovascular magnetic resonance imaging.
J Cardiol Cases2020 Jan;21(1):1-4. doi: 10.1016/j.jccase.2019.09.011.
Takuwa-Shiomi Chihiro, Ogiso Masataka, Isogai Toshiaki, Kato Ken, Tanaka Hiroyuki, Kiriu Takahiro, Masukawa Ai, Niinami Hiroshi, Hagiwara Nobuhisa,
Abstract
Peripartum cardiomyopathy (PPCM) is a rare disorder in which left ventricular (LV) systolic dysfunction and symptoms of heart failure (HF) occur in the peripartum period. The time to potential recovery from severe remodeling of ventricular function is difficult to predict. Although lack of late gadolinium enhancement (LGE) in cardiovascular magnetic resonance (CMR) is reportedly associated with functional recovery of the LV in some cardiomyopathies, the impact of LGE in PPCM remains unclear. We herein report a case of a patient with PPCM who demonstrated rapidly worsened ventricular function, leading to requirement of a paracorporeal left ventricular assist device (LVAD) implantation despite absence of LGE in CMR. A 34-year-old Japanese patient, G2P2A0, expecting her third delivery following a full-term pregnancy, experienced heart failure. Severe LV dysfunction and PPCM were diagnosed. CMR showed no LGE. Although standard HF therapy and bromocriptine were given, her cardiac function failed to recover, and she eventually underwent paracorporeal LVAD implantation as a bridge to heart transplantation due to the impossibility of stopping the administration of inotropic agents. < The prognosis of peripartum cardiomyopathy without late gadolinium enhancement in cardiovascular magnetic resonance is reportedly better than that of cases with late gadolinium enhancement. Our patient, who did not have late gadolinium enhancement, showed rapidly worsening ventricular function, leading to the requirement of paracorporeal left ventricular assist device implantation. Patents with peripartum cardiomyopathy should be monitored vigilantly even if they have no late gadolinium enhancement.>.
© 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
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Acute Herpes Simplex Virus Hepatitis in Pregnancy.
Obstet Gynecol2020 Feb;135(2):396-400. doi: 10.1097/AOG.0000000000003613.
Calix Roberto X, Loeliger Kelsey B, Burn Martina S, Campbell Katherine H,
Abstract
BACKGROUND:
Herpes simplex virus (HSV) causes only 2-4% of all acute hepatitis but has high morbidity and mortality. Pregnancy is a risk factor for HSV hepatitis. We describe a case of gestational HSV hepatitis.
CASE:
A 32-year old woman, gravida 2 para 1, presented at 38 2/7 weeks of gestation with back pain and fetal tachycardia. She became febrile after admission, had spontaneous rupture of membranes, and was delivered by cesarean for malpresentation. Postpartum, she became persistently febrile and developed transaminitis, symptomatic hypotension, and pancytopenia despite antibiotics. Imaging revealed acute liver injury, splenomegaly, pleural effusions, and cardiomyopathy. Serum polymerase chain reaction (PCR) screening identified HSV-1 infection. The patient recovered on acyclovir. There was no evidence of neonatal seroconversion.
CONCLUSION:
Herpes simplex virus hepatitis causes significant morbidity, and pregnant women are susceptible to severe infections. Pregnant or peripartum women with acute febrile hepatitis require prompt evaluation for HSV with serum PCR screening.
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Undiagnosed peripartum cardiomyopathy: Anesthesiologist's nightmare!
J Anaesthesiol Clin Pharmacol;35(4):566-568. doi: 10.4103/joacp.JOACP_221_17.
Borle Anuradha, Goswami Devalina, Meshram Tanvi, Kaur Manpreet, Akshat Shiv,
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Left ventricular function recovery in peripartum cardiomyopathy: a cardiovascular magnetic resonance study by myocardial T1 and T2 mapping.
J Cardiovasc Magn Reson2020 Jan;22(1):2. doi: 10.1186/s12968-019-0590-z.
Liang Yao-Dan, Xu Yuan-Wei, Li Wei-Hao, Wan Ke, Sun Jia-Yu, Lin Jia-Yi, Zhang Qing, Zhou Xiao-Yue, Chen Yu-Cheng,
Abstract
BACKGROUND:
Peripartum cardiomyopathy (PPCM) is rare and potentially life-threatening; its etiology remains unclear. Imaging characteristics on cardiovascular magnetic resonance (CMR) and their prognostic significance have rarely been studied. We sought to determine CMR's prognostic value in PPCM by using T1 and T2 mapping techniques.
METHODS:
Data from 21 PPCM patients from our CMR registry database were analyzed. The control group comprised 20 healthy age-matched females. All subjects underwent comprehensive contrast-enhanced CMR. T1 and T2 mapping using modified Look-Locker inversion recovery and T2 prep balanced steady-state free precession sequences, respectively. Ventricular size and function, late gadolinium enhancement (LGE), myocardial T1 value, extracellular volume (ECV), and T2 value were analyzed. Transthoracic echocardiography was performed at baseline and during follow-up. The recovered left ventricular ejection fraction (LVEF) was defined as LVEF ?50% on echocardiography follow-up after at least 6?months of the diagnosis.
RESULTS:
CMR imaging showed that the PPCM patients had severely impaired LVEF and right ventricular ejection fraction (LVEF: 26.8?±?10.6%; RVEF: 33.9?±?14.6%). LGE was seen in eight (38.1%) cases. PPCM patients had significantly higher native T1 and ECV (1345?±?79 vs. 1212?±?32?ms, P?
CONCLUSIONS:
Compared to normal controls, PPCM patients showed significantly higher native T1, ECV, and T2. Native T1, ECV, and T2 were associated with LVEF recovery in PPCM. Furthermore, ECV could independently predict left ventricular function recovery in PPCM.
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Characteristics and outcomes of pregnant women with cardiomyopathy stratified by etiologies: A population-based study.
Int J Cardiol2019 Dec;():. doi: S0167-5273(19)34756-4.
Phan Derek, Duan Lewei, Ng Angie, Shen Albert Y-J, Lee Ming-Sum,
Abstract
BACKGROUND:
Heart failure is an uncommon diagnosis among pregnant women with limited data on this condition. We sought to describe the characteristics and outcomes of pregnant women with heart failure stratified by etiologies of cardiomyopathy.
METHODS:
This is a retrospective population-based cohort study across medical centers in Southern California in the United States. Pregnant women with heart failure were identified using ICD-9 codes and adjudicated by manual review of the medical records. Obstetric complications, fetal birthweight, and maternal mortality outcomes were evaluated.
RESULTS:
Between 2003 and 2014, there were 488 pregnancies (0.1% of all pregnancies) complicated by heart failure, of which 333 (68.2%) were due to peripartum cardiomyopathy (PPCM) and 155 (31.8%) were due to other etiologies (non-PPCM). Compared to patients with non-PPCM, patients with PPCM were more likely to be Black Americans (26.7% vs 15.5%) or Asian Americans (16.8% vs 7.1%). A high proportion of PPCM patients had preeclampsia (11.1% vs 5.2%, p = 0.04). Infants born to mothers with non-PPCM were more likely to be small for gestational age (SGA) (SGA <3% 4.1% vs 9.7%, p < 0.001; SGA <10% 20% vs 8.8%, p = 0.001). No significant difference in maternal mortality was observed between PPCM and non-PPCM patients.
CONCLUSIONS:
PPCM is the most common etiology of HF during pregnancy. Infants born to mothers with PPCM were likely to be small for gestational age.
Copyright © 2019 Elsevier B.V. All rights reserved.
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Loperamide toxicity mimicking peripartum cardiomyopathy.
Am J Emerg Med2019 Nov;():. doi: S0735-6757(19)30709-0.
Wang Anderson, Nguyen Michael, Diaz Jesus, Smith Travis,
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Twenty-eight Pregnant Women with Cardiac Diseases: A Review of Maternal and Fetal Outcomes in Pakistan.
Cureus2019 Oct;11(10):e6034. doi: 10.7759/cureus.6034.
Soomro Shoaibunnisa, Kumar Raj, Shaikh Altaf A,
Abstract
Introduction In the western world, 0.2%-4% of pregnancies are complicated by heart diseases. The United Kingdom Obstetric Surveillance System (UKOSS) conducted a study on acute myocardial infarction (MI) in pregnant women. It estimated an incidence of 0.7 cases of acute MI per 100,000 pregnancies. In this study, we review the maternal and fetal outcomes of pregnant women with a cardiac disorder. Methods This retrospective analysis included all maternal records of the women registered in the obstetrics and gynecology department of Ghulam Muhammad Meher Medical Hospital, Sukkur, from January 1 to December 31, 2018. The study was approved by the institutional review board. Results The most common cardiac disease among our patients was peripartum cardiomyopathy (n=12; 42.9%) followed by rheumatic heart disease in nine (32.1%) women. The rate of maternal mortality was 14.2% (n=4). There were eight (28.6%) cases of intrauterine devices (IUDs) and the remaining 20 (71.4%) babies were born alive and healthy. Conclusion The prevalence of cardiac diseases in pregnancy in Pakistan is comparable to that in our neighboring countries. These cardiac diseases are responsible for fetal and maternal adverse outcomes.
Copyright © 2019, Soomro et al.
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Management of Heart Failure and Cardiogenic Shock in Pregnancy.
Curr Treat Options Cardiovasc Med2019 Dec;21(12):83. doi: 10.1007/s11936-019-0797-1.
Sharma Shilpa, Thomas Sunu S,
Abstract
PURPOSE OF REVIEW:
While the prognosis of peripartum cardiomyopathy (PPCM) is generally more favorable than other cardiomyopathies, PPCM can be associated with cardiogenic shock and significant maternal morbidity in young women. The management of a pregnant woman in cardiogenic shock necessitates consideration of harm to the fetus. This review focuses on the management of these women.
RECENT FINDINGS:
A number of advances have increased the repertoire of therapies available to manage PPCM. Increased understanding of PPCM pathophysiology has led to a number of new and experimental medications. In the current era, mechanical circulatory support has been gaining a stronger presence in critical care and can be used in cardiogenic shock of the pregnant patient refractory to medical therapy. We discuss medical therapies, mechanical circulatory support, arrhythmia management, and a delivery plan in the setting of cardiogenic shock secondary to PPCM.
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Sex differences in heart failure.
Eur Heart J2019 Dec;40(47):3859-3868c. doi: 10.1093/eurheartj/ehz835.
Lam Carolyn S P, Arnott Clare, Beale Anna L, Chandramouli Chanchal, Hilfiker-Kleiner Denise, Kaye David M, Ky Bonnie, Santema Bernadet T, Sliwa Karen, Voors Adriaan A,
Abstract
The overall lifetime risk of heart failure (HF) is similar between men and women, however, there are marked sex differences in the landscape of this condition that are both important and under-recognized. Men are predisposed to HF with reduced ejection fraction (HFrEF), whereas women predominate in HF with preserved ejection fraction (HFpEF). Sex differences are also notable in the penetrance of genetic cardiomyopathies, risk factors, e.g. breast cancer which may be associated with cancer treatment-induced cardiomyopathy, as well as sex-specific conditions such as peripartum cardiomyopathy (PPCM). This review outlines the key sex differences with respect to clinical characteristics, pathophysiology, and therapeutic responses to HF treatments. Finally, we address important differences in the prognosis of HF. A central hypothesis is that the higher risk of HFrEF in men compared to women may be attributable to their predisposition to macrovascular coronary artery disease and myocardial infarction, whereas coronary microvascular dysfunction/endothelial inflammation has been postulated to play a key role in HFpEF and maybe the common link among HF syndromes that women are predisposed to Takotsubo cardiomyopathy, PPCM, and breast cancer radiotherapy-induced cardiomyopathy. Under-pinning current sex disparities in HF, there is a paucity of women recruited to HF clinical trials (20-25% of cohorts) and thus treatment guidelines are predominantly based on male-derived data. Large gaps in knowledge exist in sex-specific mechanisms, optimal drug doses for women and sex-specific criteria for device therapy.
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.
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