Pregnancy Complicated with Dilated Cardiomyopathy: A Case Report (original) (raw)
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Dilated cardiomyopathy and pregnancy outcome: a case report
International journal of reproduction, contraception, obstetrics and gynecology, 2022
Cardiomyopathy is a group of diseases that affect the heart muscle. Dilated cardiomyopathy, a form of cardiomyopathy, is characterised by ventricular chamber enlargement and contractile dysfunction, and has recurrences in subsequent pregnancies. Pregnancy by itself is associated with significant hemodynamic burden and cardiovascular changes, which when coupled with dilated cardiomyopathy results in increased morbidity and mortality in both mother and child. Management of such a condition presents serious therapeutic challenge to a multidisciplinary team. Here, we report a case of a 36-year-old woman primigravida with gestational age of 11 weeks, known case of dilated cardiomyopathy. Despite the risks and associated complications with the disease, she continued her pregnancy. Patient was managed by a team of obstetrician, cardiologist and anaesthesiologist and underwent caesarean section giving birth to a live baby. The aim of this article is to provide guidance on how to manage a patient with dilated cardiomyopathy throughout her pregnancy. Early diagnosis of heart disease, regular antenatal checkups , institutional delivery and multidisciplinary approach can reduce the maternal and perinatal morbidity and mortality.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
Primary dilated cardiomyopathy is rare in women of childbearing age. Pregnancy in dilated cardiomyopathy carries high risk and can have adverse feto-maternal outcome even death. Traditionally patients of dilated cardiomyopathy with poor cardiac reserve are advised against pregnancy or termination of pregnancy in first trimester. A 26 year old patient with 5 abortions and no live issue diagnosed with Idiopathic dilated cardiomyopathy at 30 weeks at echocardiography (ECHO) with left ventricular ejection fraction (LVEF) of 25% (WHO class IV). She had no cardiac consultation earlier than in this pregnancy, though her earlier abortions were in hospital. Patient was kept with close monitoring. Dopplers parameters showed continued worsening. An emergency caesarean was done because of absent flow in ductus venosus at 34 weeks and a live child of 2.010 kg delivered. To date both mother and child are doing well. Awareness of such condition and a multidisciplinary approach is required in management of cardiomypathy in pregnancies, whose symptoms mimic that of normal pregnancy and can have adverse feto-maternal outcome.
A case of pregnancy complicated with dilated cardiomyopathy 1X
Oxford Medical Case Reports, 2015
Dilated cardiomyopathy 1X (CMD1X) is characterized by dilated cardiomyopathy (DCM) with mildest limb-girdle muscle symptoms and normal intelligence. Compound heterozygous mutation in fukutin gene is known as its genetic cause. Here, we report a pregnancy case complicated with CMD1X. A 25-year-old primiparous woman, who had been diagnosed as CMD1X at the age of 19, was referred to our hospital at 6 weeks of gestation. In early pregnancy, the evaluation of her cardiac function showed ejection fraction 47% and NYHA class II. Worsening of cardiac function was observed from 30 weeks, manifesting reduced cardiac load with left ventricular dilatation and in-hospital bed rest was necessary. Elective cesarean section was performed at 35 weeks to prevent deterioration of cardiac function. The parameters of her cardiac function returned to the pre-pregnancy status in a month after delivery, whereas she realized persistent worsening of muscular weakness at postpartum.
Cardiomyopathy in Pregnancy: A Review Literature
Heart Science Journal, 2021
Background : Pregnancy is a physiological process that many women can achieve. Pregnancy in asymptomatic patients with cardiomyopathy is usually well tolerated. However, regardless of the poor prognosis, breastfeeding cannot be accepted in the restricting form of cardiomyopathy. Prior heart events, inadequate results (NYHA with references class III or IV), or advanced left ventricular systolic dysfunction greatly increase the possibility of cardiac symptoms in pregnant women. In spite of intense medical care, clinical conditions can worsen during pregnancy. Although the incidence of cardiovascular disease is present 0.5-4% in developed countries, our knowledge about various cardiomyopathy and pregnancy should be updateable. Objective : Knowing each type of cardiomyopathy in pregnancy will help the doctor to provide a holistic approach to pregnant women Discussion : Peripartum cardiomyopathy in pregnancy is the most common type of cardiomyopathy; therefore, a thorough review is needed to give the best outcome for pregnancy. Arrhythmia is most prevalent in hypertrophic cardiomyopathy. Regular monitoring and therapeutic measures should be taken if the arrhythmia is life-threatening for the mother and child. The commonest form of restrictive cardiomyopathy in pregnancy is cardiac amyloidosis. Conclusion : Our literature provides three types of cardiomyopathies in pregnancy with an example condition for each type that is relevant during pregnancy.
Pregnancy in women with a cardiomyopathy: Outcomes and predictors from a retrospective cohort
Archives of cardiovascular diseases, 2017
Pregnancies in women with pre-existing cardiomyopathies are considered at high risk for complications. However, few data are available to characterize their natural history and predict the outcome. Our aim was to evaluate the prevalence and predictors of acute cardiac and obstetric events in women with a cardiomyopathy during pregnancy, excluding peripartum cardiomyopathy. In this retrospective study in a referral centre for cardiomyopathies, we included 43 consecutive pregnancies in 36 women with dilated, hypertrophic, arrhythmogenic right ventricular or tachycardia-induced cardiomyopathy, or left ventricular non-compaction. We observed a major cardiovascular event during 15 pregnancies (35%), including three cardiac deaths, which occurred in patients who did not follow our usual early multidisciplinary protocol. The Carpreg score was predictive of maternal complication rate (67%, 36% and 31% in women with a Carpreg score of 2, 1 and 0, respectively). However, major cardiac complic...
Pregnancy associated cardiomyopathy: Clinical profile in 137 patients diagnosed in the United States
Journal of The American College of Cardiology, 2003
Background-Cardiomyopathy associated with pregnancy was first described more than half a century ago. However, because of its rare occurrence and geographical differences, the clinical profile of this condition has remained incompletely defined. Methods and Results-Data obtained from 123 women with a history of cardiomyopathy diagnosed during pregnancy or the postpartum period were reviewed. One hundred women met traditional criteria of peripartum cardiomyopathy; 23 were diagnosed with pregnancy-associated cardiomyopathy earlier than the last gestational month. Peripartum cardiomyopathy patients had a mean age of 31Ϯ6 years and were mostly white (67%). Common associated conditions were gestational hypertension (43%), tocolytic therapy (19%), and twin pregnancy (13%). Left ventricular ejection fraction at the time of diagnosis was 29Ϯ11% and improved to 46Ϯ14% (PՅ0.0001) at follow-up. Normalization of left ventricular ejection fraction occurred in 54% and was more likely in patients with left ventricular ejection fraction Ͼ30% at diagnosis. Maternal mortality was 9%. A comparison between the peripartum cardiomyopathy and early pregnancy-associated cardiomyopathy groups revealed no differences in age, race, associated conditions, left ventricular ejection fraction at diagnosis, its rate and time of recovery, and maternal outcome. Conclusions-This study helps to define the clinical profile of patients with pregnancy-associated cardiomyopathy diagnosed in the United States. Clinical presentation and outcome of patients with pregnancy-associated cardiomyopathy diagnosed early in pregnancy are similar to those of patients with traditional peripartum cardiomyopathy. These 2 conditions may represent a continuum of a spectrum of the same disease.
Pregnancy-Associated Cardiomyopathy
Circulation, 2005
Background— Cardiomyopathy associated with pregnancy was first described more than half a century ago. However, because of its rare occurrence and geographical differences, the clinical profile of this condition has remained incompletely defined. Methods and Results— Data obtained from 123 women with a history of cardiomyopathy diagnosed during pregnancy or the postpartum period were reviewed. One hundred women met traditional criteria of peripartum cardiomyopathy; 23 were diagnosed with pregnancy-associated cardiomyopathy earlier than the last gestational month. Peripartum cardiomyopathy patients had a mean age of 31±6 years and were mostly white (67%). Common associated conditions were gestational hypertension (43%), tocolytic therapy (19%), and twin pregnancy (13%). Left ventricular ejection fraction at the time of diagnosis was 29±11% and improved to 46±14% ( P ≤0.0001) at follow-up. Normalization of left ventricular ejection fraction occurred in 54% and was more likely in patie...
2010
Background-Cardiomyopathy associated with pregnancy was first described more than half a century ago. However, because of its rare occurrence and geographical differences, the clinical profile of this condition has remained incompletely defined. Methods and Results-Data obtained from 123 women with a history of cardiomyopathy diagnosed during pregnancy or the postpartum period were reviewed. One hundred women met traditional criteria of peripartum cardiomyopathy; 23 were diagnosed with pregnancy-associated cardiomyopathy earlier than the last gestational month. Peripartum cardiomyopathy patients had a mean age of 31Ϯ6 years and were mostly white (67%). Common associated conditions were gestational hypertension (43%), tocolytic therapy (19%), and twin pregnancy (13%). Left ventricular ejection fraction at the time of diagnosis was 29Ϯ11% and improved to 46Ϯ14% (PՅ0.0001) at follow-up. Normalization of left ventricular ejection fraction occurred in 54% and was more likely in patients with left ventricular ejection fraction Ͼ30% at diagnosis. Maternal mortality was 9%. A comparison between the peripartum cardiomyopathy and early pregnancy-associated cardiomyopathy groups revealed no differences in age, race, associated conditions, left ventricular ejection fraction at diagnosis, its rate and time of recovery, and maternal outcome. Conclusions-This study helps to define the clinical profile of patients with pregnancy-associated cardiomyopathy diagnosed in the United States. Clinical presentation and outcome of patients with pregnancy-associated cardiomyopathy diagnosed early in pregnancy are similar to those of patients with traditional peripartum cardiomyopathy. These 2 conditions may represent a continuum of a spectrum of the same disease.
Pregnancy Outcomes in Women With Dilated Cardiomyopathy
Journal of The American College of Cardiology, 2009
The objectives of this study were to determine adverse outcomes during pregnancy in women with dilated cardiomyopathy (DCM) and to compare their cardiac outcomes with those of nonpregnant women with DCM.Women with DCM are at risk for complications during pregnancy, but few studies have examined outcomes in this specific population.This was a substudy of a larger prospective cohort study of outcomes in women with heart disease. Maternal cardiac, obstetric, and fetal outcomes in pregnancy in women with DCM were examined. For comparison, cardiac outcomes in nonpregnant women with DCM (n = 18) matched by age and left ventricular (LV) systolic function were examined. A matched-pair survival analysis was used to compare groups.Thirty-six pregnancies in 32 women with DCM were included. Thirty-nine percent (14 of 36) of the pregnancies were complicated by at least 1 maternal cardiac event. In the multivariate analysis, moderate or severe LV dysfunction and/or New York Heart Association functional class III or IV (p = 0.003) were the main determinants of adverse maternal cardiac outcomes during pregnancy. In the subset of women with moderate/severe LV dysfunction, 16-month event-free survival was worse in pregnant women compared with nonpregnant women (28 ± 11% vs. 83 ± 10%, p = 0.02). The adverse neonatal event rate was highest among women with obstetric and cardiac risk factors (43%).In pregnant women with DCM the risk of adverse cardiac events is considerable, and pre-pregnancy characteristics can identify women at the highest risk. Pregnancy seems to have a short-term negative impact on the clinical course in women with DCM.