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      Acute Postpartum Heart Failure With Preserved Systolic Function

      case-report

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          Abstract

          Dyspnea in the postpartum period can be a symptom of a wide range of causes spanning normal pregnancy to life-threatening pathology. We describe a case of acute postpartum heart failure with preserved systolic function in the absence of pre-eclampsia or prior cardiovascular disease. ( Level of Difficulty: Beginner.)

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          Abstract

          Dyspnea in the postpartum period can be a symptom of a wide range of causes spanning normal pregnancy to life-threatening pathology…

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          2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy

          Iveta Mintale, Piotr Hoffman, Antoniu Octavian Petriş … (2018)
          Article 0 comments Cited 442 times – based on 0 reviews     Review now
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            Left Atrial Structure and Function, and Left Ventricular Diastolic Dysfunction

            Liza Thomas, Thomas H. Marwick, Bogdan Popescu … (2019)
            Defining left atrial (LA) function has recently emerged as a powerful parameter, particularly in evaluation of left ventricular (LV) diastolic dysfunction (LVDD) and heart failure with preserved ejection fraction. Echocardiographic assessment of LVDD by echocardiography remains a challenging task; recent recommendations provide a simpler approach than previous. However, the shortcomings of the proposed approach (including transmitral flow, tissue velocity, maximum left atrial volume [LAV], and estimated pulmonary artery systolic pressure), lead to the presence and severity of LVDD remaining undetermined in a significant proportion of patients. Maximum LAV is a surrogate measure of the chronicity and severity of LVDD, but LAV alone is an insensitive biomarker of early phases of LVDD, because the LA may take time to remodel. Because the primary function of the LA is to modulate LV filling, it is not surprising that functional LA changes become evident at the earliest stages of LVDD. Moreover, LA function may provide additive value, not only in diagnosing LVDD, but also in grading its severity and in monitoring the effects of treatment. The current review provides a critical appraisal on the existing evidence for the role of LA metrics in evaluation of LVDD and consequent heart failure with preserved ejection fraction.
            Article 0 comments Cited 161 times – based on 0 reviews     Review now
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              Preeclampsia is associated with persistent postpartum cardiovascular impairment.

              K Melchiorre, Heidi Sutherland, A M Liberati … (2011)
              Preeclampsia is associated with asymptomatic global left ventricular abnormal function and geometry during the acute phase of the disorder. These subclinical abnormalities in cardiac findings are known to be important in cardiovascular risk stratification for nonpregnant patients. Furthermore, epidemiological studies have also demonstrated a relationship between preeclampsia and cardiac morbidity and mortality later in life. The aim of this study was to evaluate the postpartum natural history and clinical significance of asymptomatic left ventricular impairment known to occur with acute preeclampsia. This was a prospective longitudinal case-control study of 64 subjects with preeclampsia and 78 matched controls. There were 3 time point assessments, pregnancy and 1 and 2 years postpartum. The assessments included a medical and family history, blood pressure profile, echocardiography, and 12-lead ECG. At 1 year postpartum, asymptomatic left ventricular moderate-severe dysfunction/hypertrophy was significantly higher in preterm preeclampsia (56%) compared with term preeclampsia (14%) or matched controls (8%; P values <0.001). The risk of developing essential hypertension within 2 years was significantly higher in both preterm preeclamptic women and those with persistent left ventricular moderate-severe abnormal function/geometry. The cardiovascular implications of preeclampsia do not end with the birth of the infant and placenta. The majority of preterm preeclamptic women have stage B asymptomatic heart failure postpartum, and 40% develop essential hypertension within 1 to 2 years after pregnancy. Women with a history of preterm preeclampsia may benefit from formal cardiovascular risk assessment in the 1 to 2 years after delivery to identify those who would benefit from targeted therapeutic intervention.
              Article 0 comments Cited 127 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Melinda B. Davis
                Journal
                Journal ID (nlm-ta): JACC Case Rep
                Journal ID (iso-abbrev): JACC Case Rep
                Title: JACC Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2666-0849
                Publication date PMC-release: 15 January 2020
                Publication date Collection: January 2020
                Publication date (Electronic): 15 January 2020
                Volume: 2
                Issue: 1
                Pages: 82-85
                Affiliations
                [a ]Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
                [b ]Department of Internal Medicine, Cardiovascular Division, Washington University in St. Louis, St. Louis, Missouri
                [c ]Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
                [d ]Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, California
                [e ]Barbara Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California
                [f ]Department of Medicine, Division of Cardiovascular Medicine and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
                Author notes
                [∗ ] Address for correspondence: Dr. Melinda B. Davis, Division of Cardiovascular Medicine, University of Michigan, 1500 East Medical Center Drive, SPC 5853, Ann Arbor, Michigan 48109-5853. davismb@ 123456med.umich.edu
                Article
                Publisher Item ID: S2666-0849(19)30629-1
                DOI: 10.1016/j.jaccas.2019.12.011
                PMC ID: 8301687
                PubMed ID: 34316970
                SO-VID: 7d149b49-ed49-4440-b6fa-81a1f468d40b
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 31 October 2019
                Date revision received : 26 November 2019
                Date accepted : 4 December 2019
                Categories
                Subject: Peripartum Cardiovascular Disease Mini-Focus Issue
                Subject: Case Report: Clinical Case

                Keywords: cardiomyopathy,diastolic heart failure,pregnancy,bnp, b-type natriuretic peptide,lv, left ventricular,ppcm, peripartum cardiomyopathy
                Data availability:
                Keywords: cardiomyopathy, diastolic heart failure, pregnancy, bnp, b-type natriuretic peptide, lv, left ventricular, ppcm, peripartum cardiomyopathy

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