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Preeclampsia induced cardiomyopathy - measurement using a novel noninvasive cardiac output technique
Abstract Number: SU-68
Abstract Type: Case Report/Case Series
A 22 year old previously 35 week healthy primipara was admitted with shortness of breath. Echocardiography showed moderate left ventricular dysfunction with diastolic dysfunction and moderate mitral regurgitation. The patient was given a loading dose of magnesium 4 gram and taken for a cesarean section. The parturient was assessed using noninvasive cardiac system (NICaS, NI Medical, Petach Tikva, Israel).) during the peripartum period: preoperatively, immediately after anesthesia, two minutes after baby delivered, one hour after surgery in the postoperative care ward. The NICaS ,a whole body plethysmography system measuring cardiac output and its derivatives ( mean arterial pressure (MAP), heart rate (HR), stroke volume (SV), cardiac output (CO), and total peripheral resistance (TPR), was found to be highly accurate compared to themodilation (1). Anesthesia was performed by combined spinal epidural, using 9 mg heavy bupivicaine , 20 ucg fentanyl and 100 ucg morphine intrathecally and nothing in the epidural . Oxytocin slow bolus of three units was given immediately after the baby was delivered.
Preoperatively the patient had a MAP 101mm Hg, HR 53, CO 3.9 liter/min, SV 53 milliliters (ml)and TPR 2100 dyn*sec/cm5. When compared to a group of healthy parturients undergoing similar anesthesia, this woman had a lower HR, SV and CO and higher TPR (figure). Immediately postanesthesia, MAP was 128mm Hg, HR 70, CO 5.0 l/min, SV 71 ml, and TPR 2069 dyn*sec/cm5. Compared to healthy parturients undergoing similar anesthesia, MAP and TPR were higher and SV and CO lower (figure). Post delivery, MAP was 93 mm Hg, HR 82, CO 4.7l/min, SV 57 ml, and TPR 1616 dyn*sec/cm5. Compared to healthy parturients undergoing similar anesthesia, MAP and TPR were higher and SV and CO lower (figure). One hour postoperatively, MAP was 106 mmHg, HR 98, CO 4.1 L/min, SV 42 ml, and TPR 1230 dyn*sec/cm5. Compared to healthy parturients, the same hemodynamic differences occurred (figure).The patient was transferred to the cardiac intensive care where she received intravenous hydralazine because of high TPR. Echocardiography on the following day showed improvement in left ventricular function with an ejection fraction of 55. The patient was released 4 days later with a normal echocardiography and a diagnosis of preeclampsia induced reversible cardiomyopathy.
1. Cotter G. Accurate Noninvasive Continuous Monitoring of Cardiac Output by Whole Body Electrical Bioimpedence. Chest 2004;125: 1431-1440.