PMM.40 Peripartum cardiomyopathy (PPCM) – A rare presentation with abnormal liver function mimicking HELLP syndrome

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Abstract

Objectives

To report the rare case of a woman who was induced at term for deranged liver function, was later was recognised as secondary to cardiac dysfunction and a literature review of this rare condition.

Methods

We reviewed the case notes and investigations of the above woman and collected the demographic details, predisposing risk factors, antenatal/ intrapartum and postnatal care.

Results

A 34 yr old woman in her second pregnancy, was induced at term as her liver enzymes were raised, and she had an emergency caesarean section for fetal distress. Postpartum the liver function was further deteriorating with borderline low platelets. Clinical examination revealed a cardiac murmur and echocardiogram showed right heart failure, with ejection fraction less than 30%. Cardiologists diagnosed peripartum cardiomyopathy and the woman was transferred to cardiac centre for further management.

Results

Women with PPCM usually present with dyspnea, dizziness, chest pain, cough, neck vein distension, fatigue, and peripheral oedema. They can also manifest as arrhythmias, embolic events due to the dilated, dysfunctional left ventricle, acute myocardial infarction due to decreased perfusion to the coronary arteries, jugular venous distention, S3 and S4 gallop, and hepatomegaly. Diagnosis of PPCM requires the exclusion of other causes of heart failure: myocardial infarction, sepsis, severe preeclampsia, pulmonary embolism, valvular diseases.

Conclusions

PPCM occurs in previously healthy women in the third trimester of pregnancy and up to 5 months postpartum. The incidence is low (0.1% of pregnancies) but morbidity and mortality rates are high (5%–32%) with highly variable outcomes. Early multi-disciplinary involvement including senior Obstetricians, anaesthetists, intensivists, cardiologists and neonatologists helps in improving the outcomes.

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