Miocardiopatía periparto: revisión de la literatura / Peripartum Cardiomyopathy

Resumen: La Miocardiopatía Periparto es una patología que se presenta como una insuficiencia cardíaca aguda que aparece en el último mes del embarazo o los primeros 5 meses post parto, en ausencia de otra causa identificable. A pesar de ser más frecuente en países Afrodescendientes, el efecto migratorio ha provocado un aumento en su incidencia en los países de América latina, influyendo en la morbimortalidad materna. Si bien su etiología aún no está claramente definida, se han propuesto algunos mecanismos como el aumento del estrés oxidativo, el desequilibrio de la angiogénesis y las reacciones inflamatorias que, en un organismo genéticamente predispuesto, podrían ser los desencadenantes de esta enfermedad. Su manejo aún se considera de soporte, pero se sigue investigando en alternativas terapéuticas que puedan mejorar los resultados a largo plazo. Así, el motivo de esta revisión es evaluar la evidencia disponible hasta el momento, para el enfrentamiento del equipo tratante de estas pacientes.

Abstract: Peripartum Cardiomyopathy is a diseae presenting as acute heart failure that appears in the last month of pregnancy or within 5 months postpartum, in the absence of other identifiable cause. Despite being more frequent in Afro-descendant populations, the migratory effect has caused an increase in its incidence in Latin American countries, influencing maternal morbidity and mortality. Although its etiology is not yet defined, some mechanisms have been proposed such as increased oxidative stress, angiogénesis imbalance and inflammatory reactions that in a genetically predisposed organism, could be the triggers of this disease. Supportive therapy is still the initial management. Therapeutical alternatives that are still being investigated. The main purpose of this review is to evaluate the evidence available to improve the prognosis of the disease.

Insuficiencia cardiaca congestiva en el embarazo, secundaria a miocardiopatía periparto. Reporte de caso / Congestive heart failure in pregnancy secondary to peripartum cardiomyopathy. Case report

Resumen INTRODUCCIÓN: En Estados Unidos, las cardiopatías periparto se registran en 1 de cada 4000 pacientes. Se consideran idiopáticas y se asocian con enfermedades genéticas, problemas inmunológicos y malformaciones cardiacas, sin que se tenga certeza del origen real de este tipo de enfermedades. La miocardiopatía periparto se asocia con el embarazo y el puerperio; los criterios diagnósticos incluyen: a) insuficiencia cardiaca en las últimas cuatro semanas del embarazo o en los cinco meses siguientes al parto, b) ausencia de causas identificables de insuficiencia cardiaca, c) ausencia de enfermedad cardiaca demostrable antes de las últimas cuatro semanas del embarazo y alteración de la función del ventrículo izquierdo (fracción de eyección del ventrículo izquierdo, menor del 45%). La presentación del caso ayudará a que se tenga conocimiento de este problema. CASO CLINICO: Paciente de 26 años, en curso de las 35.4 semanas de embarazo, con inicio abrupto de signos de cardiopatía congestiva: tos, edema, taquicardia e hipertensión arterial. El embarazo finalizó por cesárea, con traslado inmediato a la unidad de cuidados intensivos. La ecocardiografía reportó una valvulopatía no conocida, insuficiencia ventricular izquierda y disminución de la fracción de eyección del ventrículo izquierdo; con lo anterior se integró el diagnóstico de miocardiopatía periparto. CONCLUSIONES: Las cardiopatías periperiparto son alteraciones excepcionales, con cuadros clínicos debidamente definidos y diagnóstico complejo. Las valvulopatías son el último diagnóstico diferencial de cardiopatía congestiva peripuerperal y se han descrito pocos casos asociados con miocardiopatía periparto.

Abstract BACKGROUND: Peripartum heart disease occurs in 1 out of 4000 cases in the United States; currently, its exact origin is unknown, which is why they are called idiopathic. Genetic diseases, immunological problems and heart malformations have been associated, without being certain about the real origin of these pathologies. Peripartum cardiomyopathy is a rare pathology associated with pregnancy and the puerperium, the diagnosis criteria includes: a) Development of heart failure in the last month of pregnancy or in the 5 months after delivery, b) absence of identifiable causes of heart failure, c) absence of demonstrable heart disease prior to the last month of pregnancy and impaired left ventricular function (FEVI less than 45%). The presentation of the case will help to raise awareness about this problem. CLINICAL CASE: A 26-year-old female patient coursing second gestation in the 35.4 pregnancy week, who debuts abruptly with signs of congestive heart disease such as cough, edema, tachycardia and arterial hypertension. The pregnancy was solved by cesarean section with a subsequent stay in Intensive Care Unit, an unknown valvular disease was identified by echocardiography, as well as left ventricular failure and decreased FEVI. Finally, a definitive diagnosis of peripartum cardiomyopathy was integrated. CONCLUSIONS: Peripartum heart disease is a rare occurrence, with well-defined clinical pictures, but difficult to approach and diagnose. Where valvular heart disease is the last differential diagnosis for peripuerperal congestive heart disease, and few cases associated with peripartum cardiomyopathy have been described.

Miocardiopatía periparto en 2021: ¿con qué contamos para su tratamiento? / Peripartum cardiomyopathy in 2021: what is available for its management?

Resumen Introducción La miocardiopatía periparto (MCPP) es una condición que afecta a mujeres al final del embarazo o durante los primeros meses del periodo puerperal, caracterizada por insuficiencia cardiaca secundaria a disfunción sistólica del ventrículo izquierdo de origen idiopático; por lo tanto, esta se considera un diagnóstico de exclusión. El manejo de la MCPP resulta ser un reto que requiere un abordaje multidisciplinario que debe incluir, como mínimo, al cardiólogo y al obstetra, ya que existen especiales consideraciones debido a las precauciones que deben tomarse en cuenta para conservar la salud fetal y materna. Objetivo Realizar una revisión sobre la evidencia científica disponible hasta la fecha en relación con el tratamiento de la MCPP. Método: Se realizó una revisión sistemática de la literatura en la base de datos PubMed bajo los siguientes términos: peripartum cardiomyopathy, pregnancy and heart failure y pregnancy and cardiomyopathy. Se seleccionaron artículos sin restricción de idioma ni fecha de publicación. Conclusiones Ha habido un incremento en el conocimiento de ciertos aspectos sobre la MCPP en los últimos años; sin embargo, queda mucho por conocer con respecto a sus mecanismos patogénicos. Si bien la bromocriptina parece ofrecer buenos resultados, es necesaria mayor investigación para averiguar su verdadero rol en esta condición. Deben realizarse más estudios para evaluar los posibles beneficios y la seguridad de las nuevas terapias propuestas.

Abstract Introduction Peripartum cardiomyopathy (PPCM) is a condition that affects women towards the end of pregnancy or during the first months after delivery characterized by heart failure secondary to left ventricle systolic dysfunction of idiopathic origin, thus, it is considered as an exclusion diagnosis. PPCM management is a challenge that requires a multidisciplinary approach that must include at least the cardiologist and the obstetrician because of the precautions that must be considered to preserve fetal and maternal health. Objective To perform a review on the evidence available to date regarding the treatment of PPCM. Method A systematic review was performed on the PubMed database using the following terms: peripartum cardiomyopathy, pregnancy and heart failure y pregnancy and cardiomyopathy. Articles were selected with no language or publication date restrictions. Conclusions An increase in awareness of PPCM has occurred during the last few years, however, there is still much to discover about its pathogenic mechanisms. Bromocriptine therapy seems to offer goods results in these patients, further research is needed in order to know its true role in this condition. Other proposed therapies are yet to be studied to know their possible benefits and safety profile.

A propósito de la cardiopatía periparto: una etiología olvidada / Regarding peripartum heart disease: a forgotten etiology

Resumen Objetivo: Identificar la epidemiología clínica y los procesos diagnósticos y terapéuticos de las mujeres con miocardiopatía periparto en un centro de referencia cardiovascular. Método: Se realizó un estudio observacional descriptivo retrospectivo con pacientes de sexo femenino de entre 15 y 50 años con diagnóstico de cardiopatía periparto durante los últimos 10 años en una institución especializada de la ciudad de Medellín. Resultados: Hubo 17 mujeres con diagnóstico de cardiopatía periparto, con una edad media de 31 años (± 6.7). El número promedio de embarazos fue de 1.0, con un 52.9%. Las condiciones más frecuentes durante la gestación fueron obesidad y preeclampsia, con un 23.5% para ambas; se halló diabetes gestacional en una paciente (5.9%) y dos presentaron hemorragia del primer trimestre (11.8%). El 41.2% de las mujeres tuvieron parto vértice espontáneo. Ninguna mujer tuvo antecedentes cardiovasculares. Los síntomas presentados al momento del diagnóstico fueron deterioro de la clase funcional (100%), edema en miembros inferiores (52.9%), ortopnea (76.4%) y disnea paroxística nocturna (88.2%). La terapia farmacológica iniciada incluyó diuréticos (58.8%), inhibidores de la enzima convertidora de angiotensina (IECA) (64.7%), betabloqueadores (82.4%), bromocriptina (5.8%), ivabradina (23.5%) y antagonistas de la aldosterona (64.7%). Conclusiones: Este registro señala la similitud en nuestro medio de esta enfermedad, respecto a la epidemiología, la presentación y el manejo, con el resto del mundo. Muestra que el tratamiento farmacológico para falla cardiaca con la combinación de betabloqueadores, IECA y diuréticos sigue siendo el pilar fundamental en el tratamiento; además, destaca que la miocardiopatía periparto aún es una afección grave, con alta morbilidad y que permanece en insuficiencia cardiaca después del diagnóstico y con un riesgo importante de mortalidad.

Abstract Objective: To identify the epidemiology and the diagnostic and therapeutic processes of women with peripartum cardiomyopathy on a cardiovascular reference center. Method: A retrospective descriptive observational study was conducted with female patients between 15 and 50 years of age with a diagnosis of peripartum cardiomyopathy during the last 10 years. Results: 17 women with a diagnosis of peripartum cardiomyopathy where included, with a mean age of 31 (± 6,7) years at the time of diagnosis. The average number of previous pregnancies was 1.0 in 52.9% of the population. Obesity and preeclampsia were present in 23.5% and 18.8%, respectively. Diabetes was found in one patient (5.9%) and two had hemorrhage of the first trimester (11.8%). 41.2% of the women had a spontaneous vertex delivery. The symptoms presented at the time of diagnosis were deterioration of their functional class in 100.0%, edema in the lower limbs in 52.9%, orthopnea in 76.4% and paroxysmal nocturnal dyspnea in 88.2%. Conclusions: Our data show that peripartum cardiomyopathy occurs with a mode of presentation similar to the rest of the world, pharmacological treatment for heart failure with the combination of beta blockers, ACE inhibitors/ARBs, and diuretics continue to be the fundamental pillar in the treatment of peripartum cardiomyopathy; It is also important to note that peripartum cardiomyopathy remains a serious condition with a high rate of critically ill patients who remain in heart failure after diagnosis with a significant risk of mortality.

Miocardiopatía periparto: afección subvalorada / Peripartum cardiomyopathy: An undervalued disease

Resumen: El embarazo es un estado que impone un verdadero reto para el sistema cardiovascular materno. Existe remodelamiento cardiaco, que, junto con el incremento de la masa miocárdica y del tamaño del ventrículo izquierdo y la contractilidad miocárdica disminuida agravada por los cambios del embarazo, pueden condicionar insuficiencia cardiaca aguda durante el periodo periparto. Se considera miocardiopatía periparto cuando la función sistólica del ventrículo izquierdo y los síntomas de insuficiencia cardiaca ocurren en el último mes del embarazo y en los cinco meses posteriores al parto con incidencia de 1 por cada 1300 a 15,000 embarazos. Se comunica el caso de una paciente de 26 años, con antecedente de catarata congénita, que tuvo embarazo normoevolutivo, con parto eutócico, durante el puerperio tuvo disnea y datos de hipoperfusión, mediante evaluación ultrasonográfica pulmonar y cardiaca mostró datos de miocardiopatía dilatada periparto, fue trasladada a un hospital de tercer nivel, donde a pesar del tratamiento intensivo multidisciplinario, falleció. La miocardiopatía periparto es una enfermedad subvalorada con alta mortalidad materna y perinatal; sin embargo, la detección oportuna puede mejorar el tratamiento y el pronóstico. Con la comunicación de este caso, se pretende demostrar la importancia de la detección temprana de una afección poco diagnosticada, como es la miocardiopatía periparto.

Abstract: Pregnancy is a state that imposes a real challenge for the maternal cardiovascular system. There is a cardiac remodeling, which along with an increase in myocardial mass, in left ventricular size and decreased myocardial contractility aggravated by changes in pregnancy, can condition acute heart failure during the peripartum period. Peripartum cardiomyopathy is when the systolic function of the left ventricle and the symptoms of heart failure occur in the last month of pregnancy and in the five months after delivery with an incidence ranging from 1/1300 to 1/15,000 pregnancies. This paper reports the case of a 26-year-old female patient, who had a history of congenital cataract, with normal pregnancy and eutocic delivery; during the puerperium patient showed dyspnea, hypoperfusion data and pulmonary and cardiac ultrasonographic evaluation of peripartum dilated cardiomyopathy, being transferred at a third level, where despite intensive multidisciplinary treatment, the patient died. Peripartum cardiomyopathy is an undervalued disease that has a high maternal and perinatal mortality; however, a timely detection can improve treatment and prognosis. The purpose of this case report is to demonstrate the importance of early detection of a poorly diagnosed entity, such as peripartum cardiomyopathy.

Miocardiopatía periparto / Peripartum cardiomyopathy

Resumen Dentro de las indicaciones para practicarse una autopsia médico-legal en Costa Rica, se encuentran las muertes súbitas o causas judiciales para investigación por mala práctica médica, donde en ocasiones hay casos de mujeres en su embarazo tardío, así como en periodo post-parto. Este artículo busca conocer aspectos acerca de un diagnóstico específico que debe tomarse en cuenta durante el análisis forense en una autopsia de mujeres en periodo comprendido entre el último mes de embarazo y los 5 posteriores al parto: la miocardiopatía periparto. Esta entidad patológica se determina por su establecimiento en el lapso del tiempo anteriormente expuesto y trata de una forma de cardiomiopatía dilatada no tan habitual, pero con una morbimortalidad elevada y por tanto, en el ámbito de la patología forense es de carácter trascendental conocerlo. Este artículo busca conocer su fisiopatología, así como sus manifestaciones clínicas y diagnóstico dentro del enfoque patológico forense.

Abstract Some of the indications to perform a legal autopsy in Costa Rica, are the sudden deaths as well as judicial inquiries to investigate malpractices causes; in many cases these autopsies are of women in their last pregnancy month or in their post-natal period, specially in the first 5 months. This article search to learn aspects of a specific diagnosis that has to be thought during the forensic analysis of an autopsy of women in the period between the last month of gestation and the first 5 months postpartum: the peripartum cardiomyopathy. This pathology is an unusual kind of dilated cardiomyopathy with a high morbidity and mortality, and so is transcendental to know about it. The goal of this article is to learn about its pathophysiology as well as its clinical manifestations and diagnosis inside the forensic approach.

Peripartum Cardiomyopathy Treatment with Dopamine Agonist and Subsequent Pregnancy with a Satisfactory Outcome / Tratamento da miocardiopatia periparto com agonista dopaminérgico e subsequente gestação com resultado satisfatório

Abstract Pathophysiological mechanisms of peripartum cardiomyopathy are not yet completely defined, although there is a strong association with various factors that are already known, including pre-eclampsia. Peripartum cardiomyopathy treatment follows the same recommendations as heart failure with systolic dysfunction. Clinical and experimental studies suggest that products of prolactin degradation can induce this cardiomyopathy. The pharmacological suppression of prolactin production by D2 dopamine receptor agonists bromocriptine and cabergoline has demonstrated satisfactory results in the therapeutic response to the treatment. Here we present a case of an adolescent patient in her first gestation with peripartum cardiomyopathy that evolved to the normalized left ventricular function after cabergoline administration, which was used as an adjuvant in cardiac dysfunction treatment. Subsequently, despite a short interval between pregnancies, the patient exhibited satisfactory progress throughout the entire gestation or puerperium in a new pregnancy without any cardiac alterations. Dopamine agonists that are orally used and are affordable in most tertiary centers, particularly in developing countries, should be considered when treating peripartum cardiomyopathy cases.

Resumo Os mecanismos fisiopatológicos da miocardiopatia periparto ainda não são totalmente definidos, apesar de haver forte associação com vários fatores já conhecidos, incluindo a pré-eclâmpsia. O tratamento segue as mesmas recomendações para a insuficiência cardíaca com disfunção sistólica. Estudos clínicos e experimentais recentes sugerem que os produtos de degradação da prolactina podem induzir a miocardiopatia. A supressão farmacológica da produção de prolactina por agonista do receptor D2 da dopamina, bromocriptina ou cabergolina, vem demonstrando resultados satisfatórios na resposta terapêutica do tratamento. Apresentamos o relato de uma primigesta, adolescente, com miocardiopatia periparto que evoluiu para a normalização da função ventricular esquerda após a administração da cabergolina, utilizada como adjuvante na terapêutica da disfunção cardíaca. Subsequentemente, apesar do intervalo entre as gestações ser considerado curto, apresentou evolução satisfatória em uma nova gestação sem qualquer alteração cardíaca durante todo o período gestacional ou puerpério. Os agonistas dopaminérgicos, drogas de uso oral e de preço acessível para a maioria dos centros terciários, em particular em países subdesenvolvidos, não podem ser esquecidos frente a casos de miocardiopatia periparto.

Anestesia para embarazada con miocardiopatía asociada al embarazo / Anesthesia for Pregnant Patient with Pregnancy Associated Cardiomyopathy

La miocardiopatía asociada al embarazo o periparto es una forma de miocardiopatía dilatada que se caracteriza por un mejor pronóstico; se distingue por insuficiencia cardíaca en el último trimestre del embarazo o en los primeros seis meses postparto, su presentación clínica es similar a la insuficiencia cardíaca de cualquier causa. El manejo anestésico es importante para el mantenimiento hemodinámico, lo cual se logra al evitar el uso de fármacos que producen depresión miocárdica, al conservar la normovolemia y al prevenir aumentos en la postcarga. Se reportó el manejo anestésico de una paciente con 32 semanas de gestación y miocardiopatía periparto, que acudió al Servicio de Anestesiología del Hospital Lenin. Se seleccionó la técnica anestésica general orotraqueal, se premedicó con midazolán + fentanil 1 µm/kg, inducción con tiopental 1% con 4 mg/kg y mantenimiento con oxígeno, óxido nitroso, fentanilo y vecuronio. Al término del procedimiento, se revirtió el bloqueo neuromuscular y se extubó a la paciente sin complicaciones.

Pregnancy associated with cardiomyopathy or peripartum is a form of dilated cardiomyopathy. It ischaracterized by a heart failure in the last period of pregnancy or in the first six months postpartum. The clinical presentation is similar to a heart failure of any cause. Anesthetic management is very important in hemodynamic maintenance; this is accomplished by preventing myocardial depression produced by drugs. The anesthetic management in a patient with early presentation of peripartum cardiomyopathy was reported in this article. Patient was admitted to the anesthetic department at 32 weeks of gestation for emergency cesarean section requiring general anesthesia. Orotracheal General anesthetic technique was selected, he was premedicated with fentanyl midazolam + 1 µm/kg, Thiopental induction with 1% to 4 mg/kg and maintained with oxygen, nitrous oxide, fentanyl and vecuronium. At the end of the procedure, the neuromuscular blockade was reversed and the patient was extubated without complications.

Miocardiopatia periparto após cesariana: studo de casos / Peripartum cardiomyopathy after caesarean section: case studies

Miocardiopatia periparto é condição rara e indefinida,que afeta predominantemente mulheres dedescendência africana, multíparas e com idade acimados 30 anos. A principal característica consisteem insuficiência cardíaca materna no último mêsde gestação ou em até cinco meses após o parto. Adisfunção ventricular ocorre mesmo sem antecedentede cardiopatia e em mulheres previamentesaudáveis. Relatam-se dois casos de miocardiopatiaocorrendo após a realização de cesarianas, em umamultípara e em uma primigesta, sem antecedentesde cardiopatia. O diagnóstico foi estabelecido combase em exames complementares, incluindo-se radiografiade tórax, eletrocardiograma e ecocardiograma.O tratamento visa a melhorar o inotropismocardíaco e reduzir as manifestações de congestãopulmonar associados. Pesquisas são necessárias paraesclarecer e estabelecer a melhor opção terapêuticapara essa desafiante entidade clínica.

Peripartum cardiomyopathy is a rare condition of unknownetiology which predominantly affects women ofAfrican descent, multiparous, and over 30 years of age.The main characteristic of this condition is maternalheart failure in the last month of pregnancy or up to fivemonths postpartum. Ventricular dysfunction occurseven without history of heart disease, and in previouslyhealthy women. We report two cases of cardiomyopathyfollowing caesarean sections in a primigravida and in a multipara without previous heart disease. Diagnosis wasestablished based on complementary exams, includingchest X-ray, electrocardiogram, and echocardiography.Treatment seeks to improve cardiac inotropism and reducethe associated symptoms of pulmonary congestion.Further research studies are required to better clarifythe etiology of the disease, as well as to establish the besttreatment option for this challenging clinical entity.

Miocardiopatia periparto: relato de caso / Peripartum cardiomyopathy: case report

A miocardiopatia periparto é uma entidade relativamenterara, caracterizada por insuficiência cardíaca derápida evolução, que ocorre entre o último mês de gestaçãoe os cinco primeiros de puerpério. Sua etiologiaé desconhecida e o diagnóstico é muitas vezes tardiopela confusão com sintomas semelhantes aos de gestantese puérperas saudáveis, tendo como consequênciao atraso no início do tratamento e uma alta taxa demortalidade. O caso relata uma paciente jovem que desenvolveumiocardiopatia periparto no primeiro mês depuerpério, associada a complicações tromboembólicas.

Peripartum cardiomyopathy is a relatively rare entity,characterized by heart failure with fast progression,which occurs between the last month of pregnancyand first five months postpartum. Its etiology is unknownand diagnosis often delayed by confusion withsymptoms similar to those of healthy pregnant andpostpartum women, resulting in the delay in startingtreatment and a high mortality rate. The case reports ayoung patient who developed cardiomyopathy in herfirst month postpartum, associated to thromboemboliccomplications.

Miocárdio não-compactado como diagnóstico diferencial de cardiomiopatia periparto: A propósito de um caso

A cardiomiopatia periparto (CMPP) é uma das causas comuns de cardiomiopatia secundária de etiologia desconhecida. Caracteriza-se pela presença de insuficiência cardíaca congestiva (ICC) materna, no último mês de gestação ou até cinco meses pós-parto, com disfunção ventricular sistólica esquerda, na ausência de outras causas de insuficiência cardíaca e em mulheres previamente saudáveis. A terapêutica médica consiste no bloqueio neuro-hormonal, suporte inotrópico, redução da pré e pós-carga cardíaca e anticoagulação. O transplante cardíaco está reservado aos casos graves e refratários à terapêutica medicamentosa. O prognóstico é variável: aproximadamente 50-60% das pacientes recuperam completamente a função cardíaca, na maioria das vezes dentro dos primeiros seis meses. Relata-se um caso de mulher negra, 37 anos, multípara, pré-natal sem intercorrências, sem comorbidades prévias ou uso de drogas, que desenvolveu um quadro de ICC, de instalação súbita, com disfunção ventricular comprovada ao ecocardiograma 15 dias após parto normal. Houve suspeição clínica de miocárdio não-compactado (MNC) que levou a dúvida quanto ao diagnóstico de CMPP, posto ser esta um diagnóstico de exclusão. A presença de MNC foi afastada pela ressonância nuclear magnética cardíaca.

La miocardiopatía periparto (MCPP) es una causa frecuente de miocardiopatía secundaria de etiología desconocida. Se caracteriza por la presencia de insuficiencia cardíaca congestiva (ICC) en la madre en el último mes del embarazo o hasta cinco meses después del parto, con disfunción sistólica del ventrículo izquierdo en ausencia de otras causas de insuficiencia cardíaca en mujeres previamente sanas. El tratamiento médico consiste en el bloqueo neurohormonal, soporte inotrópico, la reducción de la pre y post-carga cardíaca y anticoagulación. El trasplante cardíaco está reservado para casos graves y refractarios al tratamiento farmacológico. El pronóstico es variable: aproximadamente el 50-60% de las pacientes recuperan completamente la función cardíaca, en la mayoría de los casos en los primeros seis meses. Se presenta el caso clínico de una mujer de raza negra de 37 años, multípara, prenatal sin complicaciones, sin comorbilidades previas o uso de drogas, que desarrollo ICC, de aparición súbita, con disfunción ventricular demostrada en el ecocardiograma 15 días después de un parto normal. No había sospecha clínica de miocardiopatía no compactada (MNC) que dio lugar a duda sobre el diagnóstico de MCPP, ya que éste es un diagnóstico de exclusión. La presencia de MNC fue descartada por resonancia magnética nuclear cardíaca.

Peripartum cardiomyopathy (PPCM) is a common cause of secondary cardiomyopathy of unknown etiology. It is characterized by the presence of congestive heart failure (CHF) in the mother in the last month of pregnancy or until five months after birth with left ventricular systolic dysfunction in the absence of other causes of heart failure in previously healthy women. Medical treatment consists of neurohormonal blockade, inotropic support, reduced pre-and post-cardiac load and anticoagulation. Heart transplantation is reserved for severe cases refractory to medical therapy. The prognosis is variable: approximately 50-60% of patients recover full cardiac function, in most cases in the first six months. We report the case of a black woman of 37 years, multiparous, prenatal without complications, comorbidities or previous drug use that developed CHF, sudden onset, demonstrated ventricular dysfunction on echocardiography 15 days after childbirth normal. There was no clinical suspicion of non-compaction cardiomyopathy (NCC) which gave rise to doubt about the diagnosis of PPCM, since this is a diagnosis of exclusion. The presence of NCC was ruled out by cardiac magnetic resonance imaging.

Miocardiopatia periparto: aspectos relevantes / Peripartum cardiomyopathy: relevant aspects

A miocardiopatia periparto constitui entidade clínica rara, caracterizada por dilatação cardíaca e manifestações de insuficiência cardíaca grave, capaz de evoluir de forma fatal. Ocorre nos meses finais da gestação ou precocemente no puerpério. Sua etiologia e epidemiologia ainda são pouco conhecidas. Há grande discrepância nos prognósticos observados em relatos de caso, variando desde recuperação completa da função ventricular até fatalidade. Neste artigo é relatada a apresentação da doença de forma típica. O objetivo é enfatizar sua importância para que seja instituída precocemente sua terapêutica, evitando assim sua progressão para formas graves.

Peripartum cardiomyopathy (PPCM) is a rare clinical condition characterized by cardiac dilation and signs of severe heart failure and can be fatal. Its main characteristic is to affect women in the final months of pregnancy or early puerperium. Although the high morbidity and mortality, its etiology and epidemiology are poorly known. However, the outcome reports differ widely from complete recovery to death. The article reports a case to illustrate a typical manifestation of the disease. Our objective is to emphasize the importance of the theme not only to cardiologists but also to obstetricians, as the early therapy is the most important way to prevent the progression to severe conditions. Therefore the diagnosis of PPCM requires a lot of care and attention, and preventive counseling after PPCM is important due the increased risk for recurrence in a subsequent pregnancy.

Estudo hemodinâmico na cardiopatia periparto após compensaçäo da insuficiência cardíaca / Hemodynamic study in peripartum cardiopathy following compensation of heart failure

Objetivo: Estudo hemodinâmico de pacientes com cardiopatia periparto, em condiçäo padronizada de compensaçäo da insuficiência cardíaca, e de distanciamento temporal do período gravídico. Casuística e Métodos: Quatorze pacientes com cardiopatia periparto, mediante determinaçäo da pressöes circulatórias, medida do débito cardíaco, e da fraçäo de ejeçäo ventricular esquerda, e estudo da ciruclaçäo coronariana, em condiçäo de repouso. Resultados: Padräo hemodinâmico muito variável, 28% dos casos apresentando características hipercinéticas com perservaçäo de valores de débito cardíaco e fraçäo de ejeçäo ventricular esquerda em níveis normais ou mesmo elevados. Nessas pacientes as resistências vasculares sistêmica e pulmonar mantinham-se em níveis relativamente reduzidos. Conclusäo: Embora os mecanismos que propiciam a instalaçäo desta padräo hemodinâmico, distinto do habitualmente verificado na cardiomiopatia dilatada, sem esse fator periparto, näo sejam esclarecidos, há a possibilidade de associaçäo a prognóstico mais favorável, em tais condiçöes

Purpose: To assess hemodynamic characteristics of patients with peripartum cardiomyopathy under standartized conditions of clinical compensation of heart failure, and more than 3 months after the end of the gravidic period. Patients and Methods: Fourteen patients with peripartum cardiomyopathy underwent left and right card iac catheterization, und er rest cond ition. Cardiac output was measured by the Fick method, left ventricular ejection fraction determined by contrast ventriculography, and the coronary circulation was studied angiographically. Results: The hemodynamic pattern observed was variable, with 28% of the cases showing low right and left ventricular filling pressures, normal LV ejection fraction, and normal or even elevated cardiac output, with low pulmonary and systemic vascular resistance. Conclusion: Although the mechanisms responsible for such peculiar hemodynamic characterístics, have not been elucidated, it is likely that they are associated with more benign prognosis, as compared to other patients with peripartum cardiomyopathy, who show the low-output failure commonly seen in cases of dilated cardiomyopathy