Acute and Critical Care

Case Report

Cardiology
Successful extracorporeal membrane oxygenation treatment of catecholamine-induced cardiomyopathy-associated pheochromocytoma: a case report: Sangshin Park, Min Kim, Dae In Lee, Ju-Hee Lee, Sangmin Kim, Sang Yeub Lee, Jang-Whan Bae, Kyung-Kuk Hwang, Dong-Woon Kim, Myeong-Chan Cho, Dae-Hwan Bae; Acute Crit Care. 2024;39(1):194-198. Published online May 11, 2022; DOI: https://doi.org/10.4266/acc.2021.01158

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The main mechanism of Takotsubo cardiomyopathy (TCM) is catecholamine-induced acute myocardial stunning. Pheochromocytoma, a catecholamine-secreting tumor, can cause several cardiovascular complications, including hypertensive crisis, myocardial infarction, toxic myocarditis, and TCM. A 29-year-old woman presented to our hospital with general weakness, vomiting, dyspnea, and chest pain. The patient was nullipara, 28 weeks’ gestation, and had a cachexic morphology. Her cardiac enzyme levels were elevated and bedside echocardiography showed apical akinesia, suggesting TCM. The next day, she could not feel the fetal movement, and an emergency cesarean section was performed. After delivery, the patient experienced cardiac arrest and was transferred to the intensive care unit for cardiopulmonary resuscitation (CPR). Spontaneous circulation returned after 28 minutes of CPR, but cardiogenic shock continued, and extracorporeal membrane oxygenation (ECMO) was initiated. On the third day of ECMO maintenance, left ventricular ejection fraction improved and blood pressure stabilized. On the eighth day after ECMO insertion, it was removed. However, complications of the left leg vessels occurred, and several surgeries and interventions were performed. A left adrenal gland mass was found on computed tomography and was removed while repairing the leg vessels. Pheochromocytoma was diagnosed and left adrenalectomy was performed.

Citations

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Mechanical Circulatory Support Strategies in Takotsubo Syndrome with Cardiogenic Shock: A Systematic Review
Johanna K. R. von Mackensen, Vanessa I. T. Zwaans, Ahmed El Shazly, Karel M. Van Praet, Roland Heck, Christoph T. Starck, Felix Schoenrath, Evgenij V. Potapov, Joerg Kempfert, Stephan Jacobs, Volkmar Falk, Leonhard Wert
Journal of Clinical Medicine.2024; 13(2): 473. CrossRef

Original Article

Infection
Sepsis-induced cardiomyopathy is associated with higher mortality rates in patients with sepsis: Balaram Krishna J Hanumanthu, Anika Sasidharan Nair, Adarsh Katamreddy, Jason S Gilbert, Jee Young You, Obiageli Lynda Offor, Ankit Kushwaha, Ankita Krishnan, Marzio Napolitano, Leonidas Palaidimos, Joaquin Morante, Seema S. Tekwani, Suchita Mehta, Aanchal Gupta, Harmeen Goraya, Mengyang Sun, Robert T. Faillace, Perminder Gulani; Acute Crit Care. 2021;36(3):215-222. Published online July 26, 2021; DOI: https://doi.org/10.4266/acc.2021.00234

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Abstract PDF

Background
Patients with sepsis are at risk for developing sepsis-induced cardiomyopathy (SIC). Previous studies offer inconsistent results regarding the association of SIC and mortality. This study sought to assess whether SIC is linked to mortality in patients with sepsis and to evaluate predictors of the development of SIC.
Methods
In this retrospective study, patients admitted to the medical intensive care unit with a diagnosis of sepsis in the absence of acute coronary syndrome were included. SIC was identified using transthoracic echo and was defined by a new onset decline in left ventricular ejection fraction (LVEF) ≤50%, or ≥10% decline in LVEF compared to baseline in patients with a history of heart failure with reduced ejection fraction. Multivariable logistic regression analysis was performed using the R software program.
Results
Of the 359 patients in the final analysis, 19 (5.3%) had SIC. Eight (42.1%) of the 19 patients in the SIC group and 60 (17.6%) of the 340 patients in the non-SIC group died during hospitalization. SIC was associated with an increased risk for all-cause in-hospital mortality (odds ratio [OR], 4.46; 95% confidence interval [CI], 1.15–18.69; P=0.03). Independent predictors for the development of SIC were albumin level (OR, 0.47; 95% CI, 0.23–0.93; P=0.03) and culture positivity (OR, 8.47; 95% CI, 2.24–55.61; P=0.006). Concomitant right ventricular hypokinesis was noted in 13 (68.4%) of the 19 SIC patients.
Conclusions
SIC was associated with an increased risk for all-cause in-hospital mortality. Low albumin level and culture positivity were independent predictors of SIC.

Citations

Citations to this article as recorded by

Inhibition of Pyruvate Dehydrogenase Kinase 4 Attenuates Myocardial and Mitochondrial Injury in Sepsis-Induced Cardiomyopathy
Tangtian Chen, Liang Ye, Jing Zhu, Bin Tan, Qin Yi, Yanting Sun, Qiumin Xie, Han Xiang, Rui Wang, Jie Tian, Hao Xu
The Journal of Infectious Diseases.2024; 229(4): 1178. CrossRef
Meta-Analysis of Initial Natriuretic Peptides in the Setting of Sepsis-Induced Myocardial Dysfunction
Boyong He, Xin Wang, Liguo Shi, Hongbin Cheng, Luyi Zhao
Biomarkers in Medicine.2024; 18(4): 145. CrossRef
Examining the relationship between alterations in plasma cholesterol, vascular endothelin-1 levels, and the severity of sepsis in children: An observational study
Jing Xu, Wenli Shen, Xiaotao Zhang, Hongli Zhu, Yunduo Wu, Qizheng Wang, Changqiang Cui, Li Zha, Yan Jiao Lu, Rui Liu, Xiaofei Lin
Medicine.2024; 103(28): e38348. CrossRef
The Usefulness of Strain Echocardiography as Diagnostic and Prognostic Index of Cardiac Dysfunction in Septic Patients in Correlation with Cardiac Biomarkers
Mostafa El Mokadem, Sameh El Maraghi, Rania El Hosseiny, Amr Moawad, Ahmed Yassin
Journal of Cardiovascular Echography.2024; 34(3): 114. CrossRef
Immune-response gene 1 deficiency aggravates inflammation-triggered cardiac dysfunction by inducing M1 macrophage polarization and aggravating Ly6Chigh monocyte recruitment
Song Shen, Jianhui Li, Zhonghai Wei, Yihai Liu, Lina Kang, Rong Gu, Xuan Sun, Biao Xu, QiaoLing Li
Biology Direct.2024;[Epub] CrossRef
Decreased left ventricular ejection fraction is associated with increased mortality in sepsis: A retrospective cohort study
August A. Longino, Jacqueline A. Urban, Katharine C. Martin, Katarina R. Leyba, Theresa N. Thai, Ivor S. Douglas, David S. Raymer
European Journal of Heart Failure.2024;[Epub] CrossRef
Early management of adult sepsis and septic shock: Korean clinical practice guidelines
Chul Park, Nam Su Ku, Dae Won Park, Joo Hyun Park, Tae Sun Ha, Do Wan Kim, So Young Park, Youjin Chang, Kwang Wook Jo, Moon Seong Baek, Yijun Seo, Tae Gun Shin, Gina Yu, Jongmin Lee, Yong Jun Choi, Ji Young Jang, Yun Tae Jung, Inseok Jeong, Hwa Jin Cho, A
Acute and Critical Care.2024; 39(4): 445. CrossRef
Therapeutic Dilemmas in Mixed Septic-Cardiogenic Shock
Daniela Urina Jassir, Antoine H. Chaanine, Sapna Desai, Indranee Rajapreyar, Thierry H. Le Jemtel
The American Journal of Medicine.2023; 136(1): 27. CrossRef
A case of sepsis‐induced cardiomyopathy successfully treated with venoarterial extracorporeal membrane oxygenation
Keigo Sato, Akihiro Naito, Taichi Shiratori, Masahiro Yamamoto, Kenichi Shimane, Manabu Mikami, Mariko Senda, Haruki Kume, Motofumi Suzuki
IJU Case Reports.2023; 6(1): 26. CrossRef
RNF20 deletion causes inflammation in model of sepsis through the NLRP3 activation
Anlong Qi, Yancun Liu, Jianhua Zhai, Yongtao Wang, Wang Li, Tong Wang, Yanfen Chai
Immunopharmacology and Immunotoxicology.2023; 45(4): 469. CrossRef
S100a8/a9 contributes to sepsis-induced cardiomyopathy by activating ERK1/2-Drp1-mediated mitochondrial fission and respiratory dysfunction
Feng Wu, Yan-Ting Zhang, Fei Teng, Hui-Hua Li, Shu-Bin Guo
International Immunopharmacology.2023; 115: 109716. CrossRef
Ultrasound in Sepsis and Septic Shock—From Diagnosis to Treatment
Gianluca Tullo, Marcello Candelli, Irene Gasparrini, Sara Micci, Francesco Franceschi
Journal of Clinical Medicine.2023; 12(3): 1185. CrossRef
A novel signature combing cuproptosis- and ferroptosis-related genes in sepsis-induced cardiomyopathy
Juanjuan Song, Kairui Ren, Dexin Zhang, Xinpeng Lv, Lin Sun, Ying Deng, Huadong Zhu
Frontiers in Genetics.2023;[Epub] CrossRef
Prevalence and Prognosis of Sepsis-Induced Cardiomyopathy: A Systematic Review and Meta-Analysis
Daisuke Hasegawa, Yoshiko Ishisaka, Tetsuro Maeda, Narut Prasitlumkum, Kazuki Nishida, Siddharth Dugar, Ryota Sato
Journal of Intensive Care Medicine.2023; 38(9): 797. CrossRef
Sepsis-Induced myocardial dysfunction: heterogeneity of functional effects and clinical significance
Tatyana Shvilkina, Nathan Shapiro
Frontiers in Cardiovascular Medicine.2023;[Epub] CrossRef
Research Progress on the Mechanism and Management of Septic Cardiomyopathy: A Comprehensive Review
Xue-Bin Pei, Bo Liu, Maciej Dyrbuś
Emergency Medicine International.2023; 2023: 1. CrossRef
Protein Phosphatase 2A Improves Cardiac Functional Response to Ischemia and Sepsis
Ulrich Gergs, Tina Jahn, Nico Schulz, Claudia Großmann, Uwe Rueckschloss, Uta Demus, Igor B. Buchwalow, Joachim Neumann
International Journal of Molecular Sciences.2022; 23(9): 4688. CrossRef
Feasibility and discriminatory value of tissue motion annular displacement in sepsis-induced cardiomyopathy: a single-center retrospective observational study
Jieqiong Song, Yao Yao, Shilong Lin, Yizhou He, Duming Zhu, Ming Zhong
Critical Care.2022;[Epub] CrossRef
Sepsis-Induced Cardiomyopathy Reviewed: The Case for Early Consideration of Mechanical Support
Daniel L. Plack, Olivier Royer, Etienne J. Couture, Christoph G.S. Nabzdyk
Journal of Cardiothoracic and Vascular Anesthesia.2022; 36(10): 3916. CrossRef
Association of sepsis-induced cardiomyopathy and mortality: a systematic review and meta-analysis
Yu-Min Lin, Mei-Chuan Lee, Han Siong Toh, Wei-Ting Chang, Sih-Yao Chen, Fang-Hsiu Kuo, Hsin-Ju Tang, Yi-Ming Hua, Dongmei Wei, Jesus Melgarejo, Zhen-Yu Zhang, Chia-Te Liao
Annals of Intensive Care.2022;[Epub] CrossRef
Association of Sepsis-Induced Cardiomyopathy and Mortality: A Systematic Review and Meta-Analysis
Yu-Min Lin, Mei-Chuan Lee, Han Siong Toh, Wei-Ting Chang, Sih-Yao Chen, Fang-Hsiu Kuo, Hsin-Ju Tang, Yi-Ming Hua, Dongmei Wei, Jesus Melgarejo, Zhen-Yu Zhang, Chia-Te Liao
SSRN Electronic Journal .2022;[Epub] CrossRef

Case Reports

Cardiology
Extracorporeal membrane oxygenation for takotsubo cardiomyopathy that developed after mitral valve replacement: Jeong-Hyun Choi, In Duk Oh, Eunsil Shin, Sangho Lee, Jong-Mi Jeon, Hyung-Tak Kim, Hyo-Chul Youn; Acute Crit Care. 2020;35(1):51-55. Published online April 12, 2019; DOI: https://doi.org/10.4266/acc.2018.00304

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Abstract PDF

Takotsubo cardiomyopathy is a transient systolic and diastolic left ventricular dysfunction that presents several wall-motion abnormalities, while the coronary artery shows normal findings. Because patients with Takotsubo cardiomyopathy present with symptoms similar to acute coronary syndrome, the initial diagnosis and treatment are often difficult. The condition is often precipitated by acute emotional or physical stress and frequently occurs in postmenopausal women. Takotsubo cardiomyopathy may also occur in the perioperative period after cardiac and noncardiac surgery; surgery-associated Takotsubo cardiomyopathy reportedly accounts for 3%–23% of all cases. Of these perioperative cases, cardiothoracic surgery accounted for 16%. However, few cases have been reported in patients undergoing cardiac surgery and managed with extracorporeal membrane oxygenation (ECMO). We report a case of Takotsubo cardiomyopathy managed with ECMO in a patient in the intensive care unit after mitral valve replacement.

Citations

Citations to this article as recorded by

Mechanical Circulatory Support Strategies in Takotsubo Syndrome with Cardiogenic Shock: A Systematic Review
Johanna K. R. von Mackensen, Vanessa I. T. Zwaans, Ahmed El Shazly, Karel M. Van Praet, Roland Heck, Christoph T. Starck, Felix Schoenrath, Evgenij V. Potapov, Joerg Kempfert, Stephan Jacobs, Volkmar Falk, Leonhard Wert
Journal of Clinical Medicine.2024; 13(2): 473. CrossRef
Extracorporeal Membrane Oxygenation in the Management of Takotsubo Cardiomyopathy Secondary to Mitral Valve Replacement Surgery: A Case Report
Syed Mohammed, Saptarshi Maitra
Cureus.2024;[Epub] CrossRef
Takotsubo cardiomyopathy after cardiac surgery: A case-series and systematic review of literature
Driss Laghlam, Olivier Touboul, Morgane Herry, Philippe Estagnasié, Jean-Claude Dib, Mohamed Baccouche, Alain Brusset, Lee S. Nguyen, Pierre Squara
Frontiers in Cardiovascular Medicine.2023;[Epub] CrossRef
Takotsubo Syndrome in Orthotopic Liver Transplant: A Systematic Review and Pooled Analysis of Published Studies and Case Reports
Milana Bachayev, Brian Brereton, Avilash Mondal, Bibi Amena Alli-Ramsaroop, Roshan Dhakal, Maria C. Buhl Leon, Camila M. Quinones, Mohamed Eyad O. Abdelal, Akhil Jain, Kartik Dhaduk, Rupak Desai
Transplantation Proceedings.2023;[Epub] CrossRef
Stress-Induced (Takotsubo) Cardiomyopathy After Liver Transplant Rescued with Venoarterial Extracorporeal Membrane Oxygenation
Giorgio Caturegli, Matthew A. Crane, Eric Etchill, Kate Giuliano, Michelle Nguyen, Benjamin Philosophe, Sung-Min Cho, Ilan S. Wittstein, Glenn J.R. Whitman
ASAIO Journal.2022; 68(4): e66. CrossRef
Stress cardiomyopathy in critical care: A case series of 109 patients
Parth Pancholi, Nader Emami, Melissa J Fazzari, Sumit Kapoor
World Journal of Critical Care Medicine.2022; 11(3): 149. CrossRef
A Case of Takotsubo Cardiomyopathy with ST Elevation during Total Arch Replacement
Kyoko Hayashida, Shinsuke Masuda, Kazuki Morimoto
Japanese Journal of Cardiovascular Surgery.2022; 51(5): 308. CrossRef
Risk factors for Takotsubo syndrome following cardiac surgery: A case–control study
Yun Seok Kim, Ju Yong Lim
Journal of Cardiac Surgery.2021; 36(8): 2767. CrossRef

Cardiology/Thoracic Surgery
Extracorporeal Membrane Oxygenation for 67 Days as a Bridge to Heart Transplantation in a Postcardiotomy Patient with Failing Heart and Mediastinitis: Hyoung Woo Chang, Yang Hyun Cho, Suhyun Cho, Kiick Sung, Pyo Won Park; Korean J Crit Care Med. 2015;30(4):295-298. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.295

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Abstract PDF: We report a case of successful heart transplantation after 67 days of support with venoarterial extracorporeal membrane oxygenation (ECMO) in a patient who underwent surgery for type A aortic dissection and myocardial infarction complicated by irreversible myocardial damage and a deep sternal wound infection. During ECMO support, left heart vent and distal limb perfusion were performed. Mediastinitis was treated with mediastinal washout and irrigation. Multiple complications from peripheral ECMO were successfully managed.

Stress Related Cardiomyopathy during Flexible Bronchoscopy: Jung Ar Shin, Ji Yoon Ha, Sang Yong Kim, Byoung Kwon Lee, Hyung Jung Kim, Chul Min Ahn, Yoon Soo Chang; Korean J Crit Care Med. 2013;28(2):127-132.; DOI: https://doi.org/10.4266/kjccm.2013.28.2.127

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Abstract PDF: Flexible bronchoscopy is a safe medical procedure, but the incidence rate of major complications is 0.08-0.3%. Here, we report 2 cases of stress induced cardiomyopathy, which developed immediately after flexible bronchoscopy. Stress related cardiomyopathy was confirmed by EKG, echocardiography, and coronary angiogram. The cardiac functions of these patients were fully recovered with conservative treatment. Although, the pathogenesis of stress related cardiomyopathy is not well understood, post-bronchoscopy tachycardia or arrhythmia is thought to be associated with hypoxemia or catecholamine excess. Because the clinical presentation is quite similar to acute myocardial infarction, discrete evaluations are required for appropriate treatment.

Stress-induced Cardiomyopathy Following Cesarean Delivery with Hemorrhagic Shock: A Case Report: Youn Yi Jo, Ja Young Kwon, Yoon Seong Jang, Yong Seon Choi; Korean J Crit Care Med. 2011;26(1):34-37.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.34

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Abstract PDF: Stress-induced cardiomyopathy is a recently described acute and transient cardiomyopathy with typical left ventricular apical ballooning mimicking the clinical scenario of an acute myocardial infarction. Cesarean delivery causes intense emotional and physical stresses, which may precipitate stress-induced cardiomyopathy. We report a case presenting stress-induced cardiomyopathy occurring during ICU care in the early postpartum period following cesarean delivery.

Stress-induced Cardiomyopathy Associated with Swine Influenza Infection Which Exacerbated Underlying Emphysema: A Case Report: Sung Gook Song, June Hong Kim, Kook Jin Chun, Jun Kim, Yong Hyun Park, Jeong Su Kim, Ju Hyun Park, Dong Cheul Han, Woo Hyun Cho, Doo Soo Jeon, Yun Seong Kim; Korean J Crit Care Med. 2010;25(4):245-248.; DOI: https://doi.org/10.4266/kjccm.2010.25.4.245

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Abstract PDF: Stress-induced cardiomyopathy (SICM) is an acute cardiac condition that causes left ventricular apical ballooning which mimicks acute coronary syndrome. The risk of in-hospital mortality with SICM is generally low (1% to 3%) and supportive care is usually sufficient for resolution. Swine-origin influenza A (H1N1, S-OIV) is a recently spreading pandemic and a serious public health problem. Although most S-OIV infections have a mild, self-limited course, clinical cases resulting in fatalities and associated with variable co-morbidities remain as a serious concern in some individuals. Among such serious complications, there have been few reports of SICM caused by S-OIV infection. We herein report, for the first time in the literature, a case with fatal hemodynamic instability secondary to SICM caused by S-OIV infection with viral pneumonia.

Successful Heart Transplantation after Dobutamine, Glucose-insulin-potassium, and Hormone Therapy in a Hemodynamically Unstable Cadaveric Heart Donor: A Case Report: So Yeon Kim, Shin Ok Koh, Young Chul Yoo, Ha Kyoung Kim, Tae Jin Yun, Eun Ji Chang, Sungwon Na; Korean J Crit Care Med. 2010;25(2):89-92.; DOI: https://doi.org/10.4266/kjccm.2010.25.2.89

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Abstract PDF

The major limitation to heart transplantation is the shortage of donor organs. In order to increase the cardiac donor pool, it is important to maintain stable hemodynamics and closely monitor cardiac function in cadaveric organ donors or potent donors. Recently, management of a potential cardiac donor pool has focused on aggressive hemodynamic management protocols and dobutamine stress echocardiography. In our case, management with low dose dobutamine, glucose-insulin-potassium (GIK), and hormone therapy reversed heart failure following brain death and the heart was successfully transplanted. We suggest that aggressive hemodynamic management with low-dose dobutamine, GIK, and hormone therapy can result in the recruitment of more cadaveric hearts in marginal conditions.

Citations

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Predisposing Hemodynamic Factors Associated with a Failed Apnea Test during Brain Death Determination
Eun Young Kim, Ji Hyun Kim
The Korean Journal of Critical Care Medicine.2016; 31(3): 236. CrossRef

Takotsubo Cardiomyopathy Induced after Postoperative ICU Care: Case Reports: Kuk Hui Son, Jae Seung Jung, Kwang Taik Kim, Kyung Sun, Ho Sung Son, Jae Yoon Song, Yong Hyun Kim, Sung Ho Lee; Korean J Crit Care Med. 2009;24(3):152-155.; DOI: https://doi.org/10.4266/kjccm.2009.24.3.152

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Abstract PDF

'Takotsubo cardiomyopathy' or 'stress-induced cardiomyopathy' is a newly described clinical entity that's characterized by transient left ventricular apical ballooning and left ventricular apical dyskinesis in the absence of any angiographic feature of significant coronary artery disease. The cause of takotsubo cardiomyopathy is unclear, but catecholamines probably play a role in the genesis of takotsubo cardiomyopathy. We report here on two cases of takotsubo cardiomyopathy that occurred during ICU care.

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Stress-induced Cardiomyopathy Following Cesarean Delivery with Hemorrhagic Shock - A Case Report -
Youn Yi Jo, Ja Young Kwon, Yoon-Seong Jang, Yong Seon Choi
The Korean Journal of Critical Care Medicine.2011; 26(1): 34. CrossRef

A Case of Stress Cardiomyopathy Complicated by Torsades de Pointes in a Patient with Acute Colitis: A Case Report: Hyoungyoung Kim, Gi Byoung Nam, Sang Jin Lee, Hyun Kee Lee, Yoonki Hong, Kee Joon Choi, You Ho Kim; Korean J Crit Care Med. 2007;22(2):101-105.

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Abstract PDF: A 67-year old woman, hospitalized for the management of infectious colitis, developed acute congestive heart failure. Two-dimensional echocardiography revealed left ventricular apical akinesia (ballooning) and basal hyperkinesis, which was compatible with stress cardiomyopathy. A marked QT prolongation and T wave inversion followed by nonsustained polymorphic ventricular tachycardia was noted in the electrocardiogram. Intravenous administration of magnesium completely suppressed the ventricular tachycardia. After recovery from the colitis, the follow-up ECG and echocardiogram were normalized. There was no evidence of ischemic heart disease in the coronary angiography or perfusion scan. Takotsubo cardiomyopathy is one of the most important causes of acquired QT prolongation in ICU (intensive care unit) patients.. A careful monitoring of the QT interval in these patients is warranted particularly when drugs causing QT prolongation are used.

Successful Empirical Treatment of Intravenous Immune Globulin in Recent-Onset Idiopathic Dilated Cardiomyopathy: A Case Report: Hyun Soo Kim, Keum Nam Rim, Hyun Jong Shin, Sang Pyo Lee, Sang Bong Ahn, Yong Gu Lee, Young Chul Lee, Na Rae Ha, Sun Joo Chang, Jin Ho Shin; Korean J Crit Care Med. 2007;22(2):96-100.

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Abstract PDF: Intravenous immunoglobulin (IVIG) therapy has been introduced to idiopathic dilated cardiomyopathy due to their antiviral and anti-inflammatory effects. But each study reported conflicting result and treatment regimen has not been clearly established. We experienced a case of 28-year-old woman with idiopathic dilated cardiomyopathy with severely depressed cardiac function. Its onset time was obvious within 1 month. Despite of conservative treatment of heart failure, sudden cardiac arrest was developed. We tried IVIG therapy, and her symptoms and cardiac function were improved after IVIG treatment.

Labor Analgesia with Epidural Blockade in Parturient with Peripartum Cardiomyopathy: A Case Report: Tae Ha Ryu, Jae Hoon Jeong, Dong Gun Lim, Si Oh Kim; Korean J Crit Care Med. 2004;19(2):143-147.

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Abstract PDF: Peripartum cardiomyopathy (PPCM) is an unusual and uncommon causes of antepartum and postpartum heart failure, which may result in severe cardiac failure and death. PPCM is often unrecognized as symptoms of normal pregnancy commonly mimic those of mild heart failure but can rapidly progress to cardiac failure. We presented a case of elective labor induction in a patient with peripartum cardiomyopathy. A epidural analgesia technique was performed without difficulty for labor analgesia in parturient with peripartum cardiomyopathy. Her post-delivery course was uncomplicated but her baby has died due to respiratory failure. We suggest that vaginal delivery with careful incremental epidural alnalgesia in patient with PPCM is acceptable methods and close peripartum monitoring is essential in the management of PPCM.

Anesthesia for Cesarean Section in Two Pregnant Women with Peripartum Cardiomyopathy: A report of two cases: Yong In Kang, Kyung Sook Cho, Su Yeon Kim, Myoung Hee Kim, Hyun Sook Lee; Korean J Crit Care Med. 1997;12(2):177-182.

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Abstract PDF: Peripartum cardiomyopathy (PPCM) is defined as the onset of acute heart failure without demonstrable cause in the last trimester of pregnancy or within the first 6 months after delivery. Mortality from PPCM ranges from 25% to 50% and cause of death is usually chronic congestive heart failure or thromboembolic complications. We experienced 2 patients with PPCM. One was a twin pregnant woman and PPCM was developed after cesarean section. In the other case, PPCM was combined with aspiration pneumonia in the preterm labor patient. They were treated with diuretics and cardiotonic drugs and recovered to normal cardiac function within 7 to 10 days. Prognosis is related to recovery of left ventricular function, which usually occurs within 6 months postpartum. Early diagnosis and appropriate treatment of PPCM improve outcome.

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