PERIPARTUM CARDIOMYOPATHY IN A PREECLAMPTIC PREGNANT PATIENT WITH ASSOCIATED PROLONGED QT SYNDROME.
Abstract Number: 35
Abstract Type: Case Report/Case Series
We report the case of a patient with severe preeclampsia (SP) and HELLP syndrome, with several episodes of cardiopulmonary arrest.
CASE REPORT: A 21 year old primigravid patient, with SP and HELLP syndrome was admitted after a c-section under general anesthesia for a non reassuring fetal status at 37 weeks of gestation. After surgery, we found a creatinine 1.24mg/dl, Proteinuria 580mg 24-Hour, Bilateral alveolar Infiltrates and increase in cardiothoracic index at chest x-Ray. Clinical examination showed signs of pulmonary edema.
Management was initiated with magnesium sulfate, diuretics and respiratory therapy, with improvement in clinical state. 48 hours later, a seizure followed by cardiac arrest (Torsade de pointes), with return of spontaneous circulation after 15 minutes of resuscitation maneuvers. EKG showed sinus rhythm and a QT interval of 520 ms. (Fig1). She was managed with magnesium sulfate and mild hypothermia for 24 hours, mechanical ventilation for 36 hours and vasopressors. Recovery in renal, pulmonary, and cardiovascular function was observed. The cranial CT scan was normal; no neurological deficit was found. 24 hours later, frequent bigeminy was seen withd several episodes of Torsade de pointes despite antiarrhythmic medication(Fig1). The patient was referred to a cardiovascular ICU were a temporal pacemaker was placed. An echocardiogram showed ventricular dilation and global hypocinesia, ejection fraction (EF) of 30%, pulmonary artery systolic pressure of 60 mmHg and 350cc of pericardial effusion. Cultures of myocardial tissue were negative, so a diagnosis of idiopathic dilated Cardiomyopathy was made.
18 days later an implantable cardio defibrillator was placed to prevent sudden death. A control of echocardiography a month later showed a 50% of EF and global hypocinesia. Evolution was satisfactory.
Discussion: Peripartum cardiomyopathy PC is a rare and life-threatening disease that can have potentially devastating consequences. Ventricular dysfunction in preeclampsia is uncommon, when present, looking for other causes as PC is mandatory.
Prolonged QT syndrome has not previously been associated with SP or PC. The use of oxytocin, terbutaline, vasopressors and inhaled anesthetics has been associated with this syndrome. Pregnancy reduces the risk of cardiac events, but in the postpartum period the risk increases 2- 7 fold, then the risk goes back to the previous values.
1.Can J Anesth 2007; 54 (7):561-72