Peripartum Cardiomyopathy: A Mutidisciplinary Approach

Background: Peripartum cardiomyopathy is a rare life threatening cardiac condition of unknown etiology that occurs in previously healthy women during the peripartum period and up to five months postpartum. Because of the rarity of the disorder, limited practical experience of most clinicians can lead to delayed diagnosis resulting in higher rates of complications and even death.  Heightened suspicion of clinicians is imperative when patients present with signs and symptoms of heart failure and utilization of multidisciplinary collaboration is essential to improve clinical outcomes.       

Case: A 30year old multiparous female at 38 weeks gestation, without significant medical history, presented to a suburban ER with complaints of sudden onset dyspnea, cough and lower extremity edema. After evaluation and chest x-ray revealing pulmonary edema and cardiomegaly, the patient was transferred to a MICU at a tertiary care center. On admission the patient presented with tachycardia at 121 bpm, dyspnea with 36 breaths per minute, blood pressure 131/89 and spo2 95% on 2l NC. During the obstetric consultation the patient was diagnosed with pre-eclampsia and transferred to Labor and Delivery for induction of labor and Magnesium sulfate administration.  During the course of induction, the patient continued to rapidly decompensate despite administration of Lasix, O2 support, and unremarkable lab findings with SPO2 of 85% on 15L O2, heart rate of 140, and respiratory rate of 40 with bilateral course crackles and stridor. OB safety rounds were held including Maternal Fetal Medicice, Anesthesia, and Obstetrics at which the nurse expressed concern regarding the patient's status and symptoms of cardiac failure. This led to escalation of care to include cardiology consults. Echocardiography revealed left systolic dilated dysfunction and an EF 25-30%. The patient was diagnosed with peripartum cardiomyopathy, magnesium discontinued, and additional Lasix administered. Patient had a spontaneous vaginal delivery and was immediately transferred to CVICU. IN CVICU she responded to treatment with BiPap, diuretics, nitrates, beta adrenergic blockers, and ACE inhibitors. She was discharged 5 days after delivery to be followed by outpatient cardiology.

Conclusion: It is essential to recognize early symptoms of cardiac failure in the pregnant patient by all clinicians. The establishment of multidisciplinary care and obstetric safety rounding is an essential element to expediting treatment and care of these patients. Nurses have a primary role in early assessment and  taking part in the multidisciplinary team approach to improving patient outcomes and advocating for them when expediting care. The SBAR communication tool enables the bedside nurse to properly communicate patient status.                                                                                                                                                                      

Keywords:

 Peripartum Cardiomyopathy, Multidisciplinary Safety Rounds, SBAR communication