Peripartum cardioembolic thromboembolic complications are associated with cardiac dysfunction.
Apical four-chamber view shows numerous biventricular thrombi. Photo: Cardiovascular Center of Puerto Rico and the Caribbean.
Doctors from the Cardiovascular Center of Puerto Rico and the Caribbean report the case of a Puerto Rican woman they diagnosed. peripartum cardiomyopathysevere biventricular systolic dysfunction, with concomitant biventricular thrombi, who in turn present worsening dyspnea.
The 26-year-old woman was recently diagnosed with this rare heart disease in which the heart becomes weakened and enlarged. On the other hand, the doctors reported that the patient did not comply with diuretics or warfarin.
Physical assessment and imaging of the patient
On physical examination, sinus tachycardia, hypoxemia (low blood oxygen levels), and arterial hypotension (low blood pressure) were notable. In addition, the patient presents cold lower extremities and breathing lungs, that is, breath sounds.
Tests showed leukocytosis, elevated BNP (biomarkers of heart failure), troponin, and lactic acid, while imaging tests revealed opacity in the right lower lobe.
The echocardiogram showed a Left Ventricular Ejection Fraction (LVEF) of less than 10%, also hypokinesia and dilatation of the right ventricle and several large biventricular thrombi.
Therefore, the patient was intubated and multiple vasopressors, intravenous heparin, diuretics, and antibiotics were administered. Subsequently, doctors reported that the patient remained hemodynamically unstable and died before they could attempt diagnostic and therapeutic pulmonary angiography.
Complications of peripartum cardiomyopathy
Among the findings of the case, it is highlighted that the thromboembolic complications of the peripartum cardiomyopathy are associated with hypercoagulable states, cardiac dysfunction, and venous stasis.
The predictors of worse outcomes in the peripartum cardiomyopathy they include severely reduced Left Ventricular Ejection Fraction (LVEF), right ventricular systolic dysfunction, and left ventricular thrombi.
It should be noted that rebound hypercoagulability after stopping anticoagulation can increase this risk.
In addition, clinicians believe that this case highlights the therapeutic challenges of multifactorial trauma and medication compliance in a young patient with multiple negative social determinants of health.
The authors of the study are from the Cardiovascular Center of Puerto Rico and the Caribbean – University of Puerto Rico.
Erica G. Otero-Cardenas
Hector E. Sepulveda German
Andres Cordova Toro
Carla Colon-Nuñez
Hillary Rios Torres
Maria A. Rodríguez Santiago
Marcel Mesa Pabon
Access the study here.
