A rare case of peripartum cardiomyopathy with takayasu arteritis
Keywords:Peripartum cardiomyopathy, Takayasu’s arteritis, Vasculitis, Aortic arch syndrome
29 years old primigravida 38.3 weeks came with complaints of bleeding per vaginum and sudden onset breathlessness. Major finding on examination was that there was no pulse in the left hand along with raised BP, low SPO2 and B/L crepitations. Emergency management was given and patient stabilized temporarily. D/D were discussed with acute LVF due to PPCM most likely and patient was taken up for emergency LSCS. Post section 2D ECHO was performed showing decreased EF. Peripartum cardiomyopathy is an uncommon but potential life-threatening cardiac failure of unknown etiology, encountered late in pregnancy or in the postpartum period. Diagnosis of PPCM should essentially include echocardiographic substantiation of left ventricular dysfunction. TA is a vasculitis that mainly affects women of childbearing age, so it is possible to find pregnant patients with the disease. Women with Takayasu arteritis require multidisciplinary management prior to and during pregnancy. Monitoring for and reducing risk of preeclampsia, FGR and thromboembolic disease are helpful in achieving favorable outcomes.
Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, et al. Heart Failure Association of the European Society of Cardiology Working Group on Peripartum Cardiomyopathy. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. European Journal of Heart Failure. 2010;12:767–78.
Hilfiker-Kleiner D, Sliwa K. Pathophysiology and epidemiology of peripartum cardiomyopathy. Nat Rev Cardiol. 2014;11:364–70.
Hilfiker-Kleiner D, Haghikia A, Nonhoff J, Bauersachs J. Peripartum cardiomyopathy: current management and future perspectives. European Heart Journal. 2015;36:1090–7.
Duncker D, Haghikia A, König T, Hohmann S, Gutleben K-J, Westenfeld R, et al. Risk for ventricular fibrillation in peripartum cardiomyopathy with severely reduced left ventricular function-value of the wearable cardioverter/defibrillator. European Journal of Heart Failure. 2014;16:1331–6.
Amos AM, Jaber WA, Russell SD. Improved outcomes in peripartum cardiomyopathy with contemporary. Am Heart J. 2006;152:509–13.
Sliwa K, Fett J, Elkayam U. Peripartum cardiomyopathy. Lancet. 2006;368(9536):687–93.
Fett JD, Carraway RD, Dowell DL, King ME, Pierre R. Peripartum cardiomyopathy in the Hospital Albert Schweitzer District of Haiti. Am J Obstet Gnecol. 2002;186(5):1005–10.
Demakis JG, Rahimtoola SH. Peripartum cardiomyopathy. Circulation. 1971;44(5):964–8.
Elkayam U, Akhter MW, Singh H. Pregnancy-associated cardiomyopathy. Clinical Characteristics and a comparison between early and late presentation. Circulation. 2005;111(16):2050–5.
Ray P, Murphy G, Shutt L. Recognition and management of maternal cardiac disease in pregnancy. Br J Anaesth. 2004;93:428–39.
Sliwa K, Forster O, Libhaber E. Peripartum cardiomyopathy: inflammatory markers as predictors of outcome in 100 prospectively studied patients. Eur Heart J. 2006;27(4):441–6.
Bianchi DW. Fetomaternal cell trafficking: a new cause of disease? Am J Med Genet. 2000;91(1):22–8.
Pearson GD, Veille JC, Rahimtoola S. Peripartum cardiomyopathy: National Heart, Lung and Blood Institute and Office of Rare Diseases Workshop recommendations and reviews. JAMA. 2000;283(9):1183–8.
Rauchhaus M, Coats AJ, Anker SD. The endotoxin-lipoprotein hypotesis. Lancet. 2000;346(9233):930–3.
Fett JD. Peripartum cardiomyopathy in both surrogate and biological mother. Hum Reprod. 2005;20(9):2666–8.
Sliwa K, Skudicky D, Bergemann A, Candy G, Puren A, Sareli P. Peripartum cardiomyopathy: analysis of clinical outcome, left ventricular function, plasma levels of cytokines and Fas/APO-1. J Am Coll Cardiol. 2000;35(3):701–5.
Fett JD, Christie LG, Carraway RD, Murphy JG. Five-year prospective study of the incidence and prognosis of peripartum cardiomiopathy at a single insitution. Mayo Proc. 2005;80(12):1602–6.