Cardiomyopathy. “Babies Are Breaking My Heart!”

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© Springer Nature Switzerland AG 2020
C. G. Kaide, C. E. San Miguel (eds.)Case Studies in Emergency Medicinehttps://doi.org/10.1007/978-3-030-22445-5_50



50. Peripartum Cardiomyopathy. “Babies Are Breaking My Heart!”



Meenal Sharkey1, 2   and Natasha Bodystun3, 4  


(1)
USACS, Canton, OH, USA

(2)
Doctors Hospital Emergency Department, Columbus, OH, USA

(3)
Doctors Hospital Emergency Department, Columbus, OH, USA

(4)
PGY4, Emergency Medicine Resident, Columbus, OH, USA

 



 

Meenal Sharkey (Corresponding author)



 

Natasha Bodystun



Keywords

Peripartum cardiomyopathyRisk factorsMultiparityGestationObesityPPCM


Case


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. 1.

    Hypertension.


     

  2. 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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Mar 15, 2021 | Posted by in EMERGENCY MEDICINE | Comments Off on Cardiomyopathy. “Babies Are Breaking My Heart!”

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