Canadian Journal of Anesthesia

, Volume 48, Issue 8, pp 773–777 | Cite as

Two cases of postpartum cardiomyopathy initially misdiagnosed for pulmonary embolism

  • Magdalena Lasinska-Kowara
  • Maria Dudziak
  • Janina Suchorzewska
Obstetrical and Pediatric Anesthesia

Abstract

Purpose

To underline the crucial role of urgent echocardiography in the differential diagnosis of acute respiratory and/or circulatory failure in the postpartum period.

Clinical features

A 24-yr-old woman was admitted to the intensive care unit (ICU) with a preliminary diagnosis of pulmonary embolism (PE) one week after Cesarean section. Neither computerized tomography nor Doppler sonography showed any signs of deep venous thrombosis or PE. In the ICU she required intubation and ventilatory support for acute respiratory and circulatory failure. Bedside echocardiography revealed features of left ventricular failure. A diagnosis of postpartum cardiomyopathy (PPCM) was made, appropriate treatment instituted and the patient soon improved. A 29-yr-old, previously healthy primipara presented at the Maternity Clinic on the fourth postpartum day complaining of increasing dyspnea nd fatigue. Within eight hours she required intubation, ventilatory support and subsequent defibrillation due to cardiac arrest. She was transferred to the ICU with a preliminary diagnosis of PE. She developed pulmonary edema followed by cardiac arrest with successful resuscitation. Bedside echocardiography revealed a left ventricular ejection fraction below 30% with an increased systolic diameter of the left ventricle, restrictive diastolic abnormalities and no signs of pulmonary hypertension. Peripartum cardiomyopathy was diagnosed and supportive treatment for heart failure was instituted.

Conclusion

It is possible to misdiagnose postpartum cardiomyopathy for PE. An error in diagnosis is life-threatening for the patient. Echocardiography is a valuable tool in the differential diagnosis. As a noninvasive procedure, it should be performed at the bedside as soon as possible to institute proper treatment and to avoid potentially fatal errors.

Deux cas de cardiomyopathie du postpartum diagnostiqués d’abord comme embolie pulmonaire

Résumé

Objectif

Souligner le rôle crucial d’une échocardiographie d’urgence dans le diagnostic différentiel d’une insuffisance respiratoire et/ou circulatoire aiguës du postpartum.

Éléments cliniques

Une femme de 24 ans a été admise à l’unité de soins intensifs (USI) à la suite d’un diagnostic préliminaire d’embolie pulmonaire (EP), une semaine après une césarienne. Ni la tomographie par ordinateur, ni l’échographie Doppler n’ont montré de signes de thrombose veineuse profonde ou d’EP. À l’USI, la patiente a eu besoin d’assistance par intubation et ventilation en raison d’une insuffisance respiratoire et circulatoire aiguës. L’échocardiographie réalisée au chevet de la patiente a révélé une insuffisance ventriculaire gauche. On a alors diagnostiqué une cardiomyopathie du postpartum (CMPP) et commencé un traitement approprié qui a rapidement amélioré l’état de la patiente.

Une primipare de 29 ans, auparavant en bonne santé, s’est présentée à la Clinique de maternité le quatrième jour après l’accouchement, se plaignant de dyspnée et de fatigue. En moins de huit heures, elle a eu besoin d’intubation, de ventilation et de défibrillation à la suite d’un arrêt cardiaque. Elle a été transférée à l’USI avec un diagnostic préliminaire d’EP. Un œdème pulmonaire s’est développé, suivi d’un arrêt cardiaque et d’une réanimation réussie. L’échographie faite au chevet de la malade a montré une fraction d’éjection ventriculaire gauche audessous de 30 % ainsi qu’une augmentation du diamètre systolique du ventricule gauche, des anomalies diastoliques restrictives mais aucun signe d’hypertension pulmonaire. Une cardiomyopathie du péripartum a été diagnostiquée et un traitement de soutien instauré pour l’insuffisance cardiaque.

Conclusion

Il est possible de confondre la cardiomyopathie du postpartum et l’EP C’est une erreur de diagnostic qui peut être grave pour la patiente. L’échocardiographie est alors un outil précieux pour le diagnostic différentiel. Comme ce n’est pas une intervention effractive, elle peut être faite au chevet du malade aussi tôt que possible pour permettre l’instauration du traitement requis et éviter des erreurs potentiellement fatales.

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Copyright information

© Canadian Anesthesiologists 2001

Authors and Affiliations

  • Magdalena Lasinska-Kowara
    • 1
  • Maria Dudziak
    • 2
  • Janina Suchorzewska
    • 1
  1. 1.Department of Anaesthesia and Intensive CareInstitute of Cardiology, Medical University of GdanskGdanskPoland
  2. 2.Non-invasive Cardiovascular Diagnostic Unit, Institute of CardiologyMedical University of GdanskPoland

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