Anesthesia in a patient with peripartum cardiomyopathy

Abstract

The normal progress of pregnancy, childbirth or the puerperium may occasionally be affected by the onset of heart failure. The origin is mostly caused by the presence of previous cardiovascular disease, known or unknown, and by iatrogenesis. Peripartum cardiomyopathy is a heart failure secondary to left ventricular systolic dysfunction, towards the end of pregnancy, or in the months following childbirth, where there is no other cause of heart failure. We present the case of a 22-year-old multiparous pregnant woman with a past medical history of bronchial asthma without an attack in the last 5 years, of being a smoker during the whole pregnancy, with a gestation time of 37 weeks, who was referred with a non-expectorating dry cough, tachycardia, non-exertional dyspnea, recurrent syncopes and episodes of paroxysmal supraventricular tachycardia. At the intensive care unit of the "Manuel Ascunce Domenech" General Teaching Hospital of Camaguey, a diagnosis of peripartum cardiomyopathy was made. Treatment with anticoagulants, beta-blockers and diuretics was started. At week 38, emergency caesarean section was ordered, administering regional epidural anesthesia with lidocaine 2 % and morphine. On the fourth day of the postoperative period, sudden death appeared.

Keywords

• cardiomyopathies
• anesthesia, conduction
• cesarean section
• peripartum period
• death, sudden, cardiac