HYS Case Report

7/21/2019 HYS Case Report

http://slidepdf.com/reader/full/hys-case-report 1/30

L/O/G/O

CASE REPORT 2014

PERIPARTUM CARDIOMYOPAHariyasa Sanjaya

Fetomaternal Division, OBI! De"artment, Me#i$al Fa$%lty,U#a ana Universit San la' eneral Hos ital Den asar Bali I



July 29, 2013

Name : DUR Age : 26 years old

Occua!"o# : $ouse%"&e 'duca!"o# : Ge#eral $"g( )c(ool

IDENTITY



*a"# comla"#! :Dys#ea s"#ce 3 days +e&ore (os"!al"ed,

-#o%# (yer!e#s"o# s"#ce ge#eral ("g( sc(ool,

out of schedule visit to OPC

L*. : /1/2013

'DD : 1/10/2013

.N : OG s"#ce GA 20%2d

ANAMNESIS



Obstetric history :

)( *, IUFD, A + m(o, San&la' 'os"ital,-))

( ., /-- &rams, Termination e($Im"en#in& e0lam"sia, San&la''os"ital, -), 1

3. Current pregnancy

Married 1x~3 years

Contraception (-)



PHYSICAL AND OBSTETRIC EXAM

Present St :BP : 160/110 mmHg

RR : 32 x/menit

P : 132 x/menit

tax : 36,8 C⁰

General St :

Thorax :

Co : S1S2 single, reguler,

murmur (+)

Po : ves +/+, rhonchy+/+, wh -/-

!stre"ities : #e"a -/-

+/+

$%stetri& St :'%#o"en : () 3 *ingers a%ove u"%ili&al no uterine &ontra&tion, () :12 %"

.T :C 1 &", e** 20, '+

)ea# ala%le, #eno"inator un&lear,

4) 5, unala%le s"all arts/u"% &or# US :

(etus S/, () +, (+ '. : 28w6# : 1/17/2713 ( : 1291 gra"s Pla&enta &orus anterior gr 55 '(5 1,1



DIAGNOSTIC AND CONSULT

o Thorax P' 29/;/2713 :Pul"onar< e#e"a an# ilateral leural e**usion

Pre!iou" #choc$r%iogr$&hy (13/11/2012) :

'roriate to )), Se&on#ar< o#erate, ' il#, S<stoli&

*un&tion . =or"al( %ilane 660



Consult fro ot!"r #"$%rt"nt&

'#R* 29/;/2713 :' : Sueri"ose# P

Tx : eth<l#oa 2x27 "g

o

=i*e#iine 3x17 "g o

)al* sitting osition

%%%!(emegallerycom

*R'-.- 29/;/2713* : HH

R mo%er$te, *R i%

# 66 4

H "t '' e5c Su&erim&o"e%

P# #S occ$"ion$

Pumon$ry e%em$

Suggest: eth<l#oa 3x12 "g o

=i*e#iine 3x27 "g o

Planning : eeat &ho&ar#iograh<

a% 29/;/2713

Protein +1



Ax :

G3!"!! "# $%s& '& *O+& 'uperi,posed &pu,onary ede,a

> ')( Pro*ile e?& eriartu" #ilate# &ar#io"<oath<

> ' "il#, "o#erate, P "il#, T "il#, ( 2@ 0 dx : -

/x :- O" 0 p,

- conseratie bed rest $ith se,i2o$er position

- MgSO4

- exa,ethasone 1x1" ,g 4M (" days)

- 5i2edipine 3x1! ,g po

- Other therapy as per as 4nterna and Cardioogy ept.

DIA'NOSIS AND MANA'EMENT



6 day ater

%%%!(emegallerycom

1 "t 7-' -#R##:

4 - -S#R*'# until G' 3@ w!s #ue to atient reAuest

- )ositaliBe#

4 *R'-.- :&lose "onitoring, "onitoring volu"e with &ontinuous

CG 2-3 #a<s, "axi"iBe *# inhi8itor, i"rove"ent + will %erela&e# with 8et$ 8oc9er

- -B : will %e hel# *etal assess"ent an# et$ "u&&y ine assess"ent?

(or "other : sitting osition, ox<genation, oti"iBing

- P#'*R' : =5CD, stan# %< ventilator a*ter #eliver< #is&ussion with

"anage"ent an# "e#i& &o""ittee *or sur*a&tant not covered by

jampersal

- #PHR-.- : treat in*e&tion anti%ioti&



7eta Assess,ent

4(etus Singleton, live, () +, ( +, hea# resentation

4 37 wee! 1#a<

4( : 1@89 E170

4'(5 : 13,3

4S/ atio : 2,6

45 : 7,1

4P5 : 7,;9

4Pla&enta anterior gra#e 55

%%%!(emegallerycom



"nd 8O45/ CO5795C

- Patient in 5CCD until G' 3@ wee!

- onitoring e&ho&ar#iograh< #a<s

-'C 5nhi%itor with "onitoring #oler velo&i"etr< *etal renalis

arter<-5* "other or *etus &on#ition worsening then e"ergen&< CS will

%e er*o"e#?

-DSG oler velo&i"etr< in one wee!

-CC F Hemostatic profile ever< 3 #a<s

%%%!(emegallerycom



Car#iolog<:

' : ')( Pro*ile i"rove# et&?

ilate# &ar#io"<oath</(C 555

"o#erate, ' "il#, T "il#, P

"il#

G3P7727 31-32 w!s?, S/, $

Sueri"ose# P

DSG aternal (etal:

(etus S/, () +, ( +, hea#

res

'. : 37w2# : 27/17/2713

( : 19@ g

Pla&enta *un#us &orus anterior gr 55

'(5 : 12,;

D"%ili&al arter< :

S/ :3,;1, 5 :7, ;3, P5 : 1,@2

DSG aternal (etal:

(etus S/, () +, ( +, hea# res

'. : 31w7# : 22/17/2713

( : 1;6 g

Pla&enta &orus anterior gr 55

'(5 : ;,19

D"%ili&al arter< :

S/ : 3,13, 5 : 7,68, P5 : 1,1;' : G3P7727 32-33 w!s, S/, $)

Sueri"ose# P, ')( ro*ile e?&

#ilate# &ar#io"<oath< eriartu"/(C

555, "o#erate, ' "il#, P "il#,

T "il#, eAuivo&al oligohi#a"nion

( : 1;6 gP#x

Tx : C-se&tion 21/8/2713 at

$erating Central oo"



"1 days ater

4 ale %a%< was %orn %< ele&tive C- Se&tion

1337 gra" , 'S : ;-8 =S : 22 32-33 wee!

SG', CT. + right an# le*t *oot

%%%!(emegallerycom



"0 days ater

4S : Su##enl< not a%le to sea!, Mouth weakness to the left

4$ : P 137/177 "")g

4' : - S=) e?& e"%oli ##/thro"%oe"%olis"

4 ##/ thro"%us

4 - P7371 ost CS #a< .555 *ollow u4 Sueri"ose# P

4 - ')( ro*ile e?& #ilate# &ar#io

4 "<oath< eriartu" (C 555

4 - "o#erate, ' "il#, P "il#,

4 T "il#

4S Sc$n :

4Su8 $cute i"chemic cere8r$ in$rction $t right tem&or$ o8e

%%%!(emegallerycom



3rd 8O45/ CO5795C

euroogy :

-'&etosal, Citi&olin,, o%oransia

4-Suggest reeat CT S&an #a< 555 %e&ause &lini&al insigni*i&an&e to ra#iologi& result

4-Suggest Trans Cranial oler TC to #eter"ine the &ause o* S=) not urgent

4-Patient "ove# to awar ar#

*ne"the"i$ :

4-i#ural anesthesia given %e*ore ha# less e**e&t to S=)

4-i#ural anesthesia will %e re"ove# soon an# rela&e# with oral analgesi&

-B :

- Breastfeed &ontinue, with #ail< Catoril as treat"ent-Give attention to "other s<&h, Give &han&e *or "other-&hil# &onta&t %< au#io visual

"e#ia ai#

-Consult to Rehab medic dept. and clinical nutrition

- =eurolog< has the "ost i"ortant role *or the next &are

%%%!(emegallerycom



#PHR-.- :

4-'gree to &ontinue Catoril

*R'-.- :

4-aintain atient 'P

4-Catoril is not a &ontrain#i&ation *or breastfeed

P#'*R' :

4-=ow ( is 1@77 g, no in*e&tion =5CD &are with "o#erate rognosis

4-Pro%le"s :

4 - Haun#i&e %iliru%in 13 "g/#l hotothera<4 -CT. &onsult orthoe#i&: will %e treate# with serial cast

%%%!(emegallerycom

3rd 8O45/ CO5795C



3 days ater

4 Mother $as discharge ho,e andcontinue $ith outpatient care

4 *aby sti ie unti today $ith goodcondition

%%%!(emegallerycom





'5clus"o# d"ag#os"s

cr"!er"a +ased o# N$L7 :

1. Heart failure in the end of pregnancy or

within 5 months after delivery 2No re8"ous (ear! d"sease

3No "de#!"&"ed cause o& (ear! &a"lure

Le&! 8e#!r"cle sys!ol"c dys&u#c!"o# ec(ocard"ogra(y cr"!er"a

"ll"ams et al , 200;<

PERIPARTUM CARDIOMYOPATHY



;A2ro-A,erican race : 11<"1 delivery

;+ispanic race : 1#061 delivery

;Caucasian race : 1<!= delivery

;Asia race : 1"6= delivery

(*rar et al& "!!=)

INCIDENCE



> Mother age ?3! y.o> +ypertension (reeca,psia)

> A2rica-A,erica race

> Mutiparty> Mutipe gestation

> Obesity

(Mishra et al&"!!6)

RIS( )ACTOR



> Myocarditis> Abnor,a i,,une response to pregnancy

> Maadaptie response to he,odyna,icstress in pregnancy

> Cyto%ine stress-actiated

> roonged tocoytic

> 9eaxin abnor,aity

> 'eeniu, de@ciency

(earson et al& "!!!)

ETIOLO'Y



> suay postpartu,> 'i,iar $ith nor,a postpartu, sy,pto,

(dyspnea& s$eing& 2atigue)

> too ate to %no$n by diagnostic

> /ypica heart 2aiure signs and sy,pto,s :

- dyspnea

- orthopnea

- cough

(Biia,s et al& "!!0)

SI'NS AND SYMPTOMS



> Other sy,pto,s :

- 7atigue

- 5onspeci@c heart burn

- Abdo,ina pain

> Low incidence :- 'yste,ic e,boi cause o2 e2t entrice

dys2unction

- Acute ,yocardia in2arct cause o2 inadeuate

coronary artery per2usion


SI'NS AND SYMPTOMS



P'ysi$al e2amination

(typically to Heart Failure):

- +ypoxia

- 8uguar ein distension

- '3 Gaop- Crac%es

- +epato,egay

34illiams et al , --/5

SI'NS AND SYMPTOMS



> CG : - sinus tachycardia

- nonspeci@c changes '/-/

- e2t entrice hypertrophy

- conduction abnor,aity : ***

> Chest D-ray : cardio,egay and pu,onary eincongestion or pu,onary ede,a& $ith or $ithoutpeura eEusion

> Echocardiography : diatation e2t atriu, andentrice& decrease o2 eFection 2raction and

2ractiona shortening


DIAGNOSTIC SUPPORT



> T'ree "rin$i"les 6

7 )(De$reasin& "reloa# 6 nitrate, #i%reti$

7 (De$reasin& a8terloa# 6 'y#rala9ine, ACE

in'i:itor 3"ost"art%m5

7 ;(In$reasin& inotro"i$ 6 :eta :lo$0er

> 4,,unogobuin

> igoxin& dopa,ine& dobuta,in (hypotension)

> Anticoaguant (bood stasis)

> ace,a%er (entricuar arrhyth,ia)> +eart transpant


MANA'EMENT



> epends on nor,aiation e2t entrice sieand 2unction in 6 ,onths postpartu,

> ! H o2 entrice 2unction recover in 6

,onths postpartu,> Fractional shortening <2! " de#and end

diastolic o$ le$t ventricle % & c# ris' o$ persistence le$t ventricle dys$unction

(Abboud et al& "!!=)

PRO'NOSIS



> "! H patients $ith peripartu,cardio,yopathy died or had hearttranspant

>Bo,en $ith persistent e2t entricedys2unction $i increase ris% o2 preter,abor and ,aterna death


PRO'NOSIS



L/O/G/O

Documents

HYS Case Report