Case Report
 
Acute pulmonary edema as clinical presentation of a peripartum cardiomyopathy in a very young patient
Riccardo Bentivegna1, Egle Corrado1, Giuseppe Coppola1, Emanuele Grassedonio2, Salvatore Novo1
1Division of Cardiology, Regional Reference Centre for Diagnosis and Care of Heart Failure, Centre for the Early Diagnosis of Preclinical Atherosclerosis and for Secondary Prevention of Cardiovascular Diseases, Department of Internal Medicine and Cardiovascular Disease, University Hospital “Paolo Giaccone”, Palermo, Italy
2Department of Radiological Sciences, University Hospital “Paolo Giaccone”, Palermo, Italy

Article ID: 100896Z01RB2018
doi: 10.5348/100896Z01RB2018CR

Corresponding Author:
Dr. Riccardo Bentivegna,
Via Alcide De Gasperi n°197,
Sciacca (AG), 92019, Italy

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How to cite this article
Bentivegna R, Corrado E, Coppola G, Grassedonio E, Novo S. Acute pulmonary edema as clinical presentation of a peripartum cardiomyopathy in a very young patient. Int J Case Rep Images 2018;9:100896Z01RB2018.


ABSTRACT

We present a case of a 20-year-old woman at 34th week of pregnancy, hospitalized because of the risk of premature delivery. Because of a progressive worsening of clinical conditions with dyspnoea and desaturation, an emergency caesarean section with healthy fetal extraction was necessary. In the immediate post-operative period there was a sudden worsening of dyspnea with hypoxic-hypercapnic respiratory failure and severe pulmonary edema, with subsequent endotracheal intubation and mechanical ventilation. Echocardiography showed left atrial and ventricular dilatation, global hypokinesia with reduced systolic function (EF 30%), moderate mitral regurgitation with symmetrical tethering of the mitral leaflets and pericardial effusion. Cardiac magnetic resonance showed a non-inflammatory pathway and was helpful to provide information in the differential diagnosis, so after a massive therapy we progressively observed a complete stabilization of the hemodynamic clinical picture, normalization of cardiac troponin and NT-proBNP levels and final full cardiac recovery. The early signs and symptoms of heart failure in peripartum cardiomyopathy may mimic physiological changes occurring during/after pregnancy, delayed diagnosis may occur. Although most patients with peripartum cardiomyopathy improve with medical therapy, nearly a third of all patients develop a worsening heart failure, and may also be associated with severe and lasting complications including cardiogenic shock and death.

Keywords: Acute pulmonary edema, Heart failure, Peripartum cardiomyopathy, Pregnancy


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Author Contributions
Riccardo Bentivegna – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Egle Corrado – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Giuseppe Coppola – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Emanuele Grassedonio – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Salvatore Novo – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of Submission
The corresponding author is the guarantor of submission.
Source of Support
None
Consent Statement
Written informed consent was obtained from the patient for publication of this report.
Conflict of Interest
Author declares no conflict of interest.
Copyright
© 2018 Riccardo Bentivegna et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.