Peripartum Cardiomyopathy

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Step 1: View clinicals

A 25 year old woman presents with progressive dyspnea and chest discomfort for 1 day, 2 days following the delivery of her second child. Her pregnancy and labour were uncomplicated. Her medical history is negative for cardiac and respiratory disease, while her first pregnancy was free of complications. Her hemoglobin level is 11.8 g/dl.


Step 2: Order all relevant investigations

ECG

The ECG shows sinus tachycardia with nonspecific T wave inversions in leads V1 - V4.

Troponin-T assay

The qualitative Troponin-T assay is negative.

CT Pulmonary Angiogram

The CT Pulmonary Angiogram shows no abnormalities in the pulmonary vasculature.

Echocardiogram

The LV is dilated (end diastolic size: 62 mm), with diffuse hypokinesis. The EF is 29%. Grade I - II MR is present. No other valvular or structural abnormalities are noted. The RV and pulmonary arteries appear normal.


Step 3: Select appropriate management

Morphine
Diuretics
Anticoagulation
Medical Thrombolysis


Score: ★★☆