EM Quick Hits Video on Peripartum Cardiomyopathy with Catherine Varner
Peripartum cardiomyopathy – easily missed
Clinical presentation:
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- 3rd trimester or postpartum period
- Shortness of breath out of proportion to dyspnea on exertion associated with pregnancy (this is one of the reasons peripartum cardiomyopathy is missed, as the shortness of breath is attributed to either pregnancy itself or PE)
- Worsening lower extremity edema (edema is also common in normal pregnancies and so this is also easy to overlook)
Diagnostic considerations:
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- Bloodwork: D-Dimer, BNP (sensitive and specific for peripartum cardiomyopathy), Troponin
- Note: making a diagnosis of peripartum cardiomyopathy does not preclude a diagnosis of PE, in fact these patients are at higher risk than the average patient, still need consider CTPA to rule out a PE
- Imaging: start with a CXR in patients who are dyspneic prior to CT, you may be surprised by a pneumothorax or help confirm the diagnosis with the finding of pulmonary edema
- Bloodwork: D-Dimer, BNP (sensitive and specific for peripartum cardiomyopathy), Troponin
Management (same as other patients with acute heart failure as described in Episode 163 and cardiogenic shock Episode 164)
Disposition:
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- Involve cardiology
- Consider transfer to a tertiary care center
- Recurrence: patients will likely be advised not to consider not conceiving again because their risk of recurrence is high and mortality is 2% in North America
=> Bottom Line: look out for signs of heart failure in women in the peripartum period who present with shortness of breath, consider using a BNP as screening bloodwork, and be aware that these patients are at an even higher risk for PEs
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Our EM Quick Hits Video team is: Lara Murphy and Yajur Iyengar
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