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50. Peripartum Cardiomyopathy. “Babies Are Breaking My Heart!”
Keywords
Peripartum cardiomyopathyRisk factorsMultiparityGestationObesityPPCMCase
Postpartum Shortness of Breath
Pertinent History
A 32-year-old female presents to the Emergency Department (ED) via ambulance after feeling short of breath and lightheaded. She did not feel comfortable driving. She reports she has had shortness of breath for the last 2 weeks with a dry cough. She is 3 weeks status post an uncomplicated vaginal delivery. She has had lower extremity edema for the past 2 months, but it has worsened in the past 2 weeks. She denies chest pain but has had some lightheadedness. She has not had any syncope, fevers, chills, or leg pain. Her pregnancy was overall uneventful; however, she did have worsening of her chronic hypertension that required hydralazine. She was induced at 40 weeks gestation and successfully delivered a healthy baby girl.
Past Medical History
- 1.
Hypertension.
- 2.
Three weeks post-partum
Past Surgical History
None
Medications
Hydralazine
Allergies
No known drug allergies (NKDA)
Family History
Noncontributory
Social History
She denies drinking alcohol and using tobacco products.
Physical Exam
Vitals: HR 118, RR 22, BP 99/40, SpO2 88% on RA, corrected to 92% on 2 L NC
General: Sitting in the gurney, looks anxious, tachypneic.
HEENT: normal
Cardiovascular: tachycardic. Normal S1, S2 sounds, + S3
Pulmonary: moderate respiratory distress, tachypneic, conversational dyspnea, bibasilar crackles
Abdomen: Soft, nontender, nondistended
Extremities: no acute deformities, 2+ pitting edema up to the knees bilaterally. Cool extremities.
Neurological: normal
Psychiatric: normal
Pertinent Diagnostic Testing
Test | Result | Units | Normal range | ||
|---|---|---|---|---|---|
Day 1 Time 1400 | Day 1 Time 2000 | Day 3 Time 0200 | |||
WBC | 13 ↑ | 14 ↑ | 14 ↑ | K/uL | 3.8–11.0 103/mm3 |
Hgb | 11.3 | 11.1 | 10.9 ↓ | g/dL | (Male) 14–18 g/dL |
(Female) 11–16 g/dL | |||||
Na | 123 ↓ | 127 ↓ | 130 ↓ | mEq/L | 135–148 mEq/L |
K | 4.3 | 4.5 | 4.7 | mEq/L | 3.5–5.5 mEq/L |
CO2 | 18 ↓ | 18 ↓ | 19 ↓ | mEq/L | 21–34 mEq/L |
BUN | 45 ↑ | 47 ↑ | 48 ↑ | mg/dL | 6–23 mg/dL |
Cr | 1.7 ↑ | 1.9 ↑ | 1.9 ↑ | mg/dL | 0.6–1.5 mg/dL |
AST (U/L) | 43 ↑ | – | – | IU/L | 8–32 IU/L |
ALT (U/L) | 55 ↑ | – | – | IU/L | 6–21 IU/L |
TSH | 2 | – | – | uIU/mL | 0.550–4.780 uIU/mL |
BNP | 8483 ↑ | 8512 ↑ | – | pg/ml | <100 pg/ml |
Troponin (ng/mL) | 0.092 | 0.103 | 0.099 | ng/mL | < 0.11 ng/mL |
UA | 2+ ketones ↑ | – | – | – | Negative |
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