case report peripartum cardiomyopathy

8/12/2019 case report peripartum cardiomyopathy

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Lecturer :

Prof. DR. dr. Moch. Fathoni, Sp. JP(K), FIHA

By:Fitrian Sufianasari (G99122048)



Name : Mrs. S.MAge : 30 years oldGender : FemaleReligion : MoslemOccupation : Housewife

Address : Jebres, SurakartaMedical Record : 01224878Hospitalized : January 15 th 2014



SHORTNESS OF BREATH



• Patient has been complaining shortness ofbreath , getting worse in two days beforeadmission to the hospital. It is triggered byactivity and not relieved by rest .

• Patient slept with three pillows and morecomfortable on seat position, often awakenedat night due to dyspnea.

•

Ankle swelling (+) 2 days before admission.• Productive cough with white sputum (+) since 2days before admission

• Palpitation (+), chest pain (-)



• This complaint occurred 3 month after she hasdelivered her 2 rd baby with sectio caesarean 6month ago .

• After the delivery, patient felt fatigue and bothof her leg were swelling . Patient also could notdo any activity after delivery because ofdyspnea.

Patient was hospitalized in RSDM 3 months ago.Diagnosed with PPCM and given medicine:furosemid, captopril, ISDN and spironolacton.But patient didn’t control.



• History of hypertension : (-)During the pregnancy : (-)• History of diabetes mellitus : (-)• History of asthma : (-)• History of allergy : (-)•

History of heart disease : (-)



• History of hypertension : (-)• History of diabetes mellitus : (-)• History of asthma : (-)• History of allergy : (-)• History of heart disease : (-)



• 2-3 meals a day, with rice, vegetables,

soya beans (tofu and tempe), she eatsegg and meat occasionally.

NUTRITIONALBEHAVIOR

• Doesn’t smoke. Doesn’t drink alcohol.LIFE STYLE

• She is an unemployment with 1 husbandand 2 children. Her husband works as alabour. Paid using BPJS facility.

SOSIOECONOMIC



• General Condition : breathlessness, Compos mentis

•

Vital Signs :BP =100/70 mmHgHR = 120 bpm, reguler, normal intensityRR =28 times/minute

Temperature = 36,2 ° C (axillar)

Nutritional status : Height 155 cm, weight 60 kgNutritional status = normoweight



Eyes : Pale conjunctiva ( +/+),Icteric conjunctiva (-/-)

Neck : JVP was increased R+ 5 cm ,No enlargement of lymphonode

Thorax : normochest, symmetrical,intercostal retractions (-)



Heart :

- Inspection :Ictus cordis was seen at SIC VI Linea Axilaris Anterior Sinistra, left andright ventricle activity was increased

- Palpation :

Ictus cordis was palpable at SIC VI 3 cm lateral of Linea Axilaris AnteriorSinistra, heaving (+), thrill (-)

- Percussion :1. Upper limit of the right heart: ICS II, linea parasternalis dextra2. Bottom right cardiac border: ICS IV, linea parasternalis dextra3. Upper left cardiac border: ICS II, linea parasternalis sinistra4. Lower left cardiac border: ICS VI, linea axillaris anterior sinistra

Impression: cardiac border was extended caudolaterally

- Auscultation:1. Heart Rate: 120 bpm, regular2. Intensity of the 1 st and 2 nd heart sound were normal, regular, pansystolic

murmurs (+) grade III/6 at the apex and LLSB



Lungs :Front

• Inspection : symmetric statically and

dynamically• Palpation : fumbling fremitus for right ↓ = left

↓ at ICS V and lower • Percussion : sonor ↓/ sonor ↓ at ICS V and

lower • Auscultation : vesicular sounds (+ ↓ /+ ↓) at ICS V

and lower , crackles (-/-), rales (+/+) in 1/2 basal areaof the lungs



Lungs :Back

• Inspection : symmetric statically anddynamically

• Palpation : fumbling fremitus for right ↓ = left↓ started from VT VII

• Percussion : sonor ↓/ sonor ↓ started from VT

VII • Auscultation : vesicular sounds (+ ↓ /+ ↓) started

from VT VII , crackles (-/-), rales (+/+) in 1/2 basal

area of the lungs



• Abdominal :Inspection : Abdomen wall was symmetric to chest wall

Auscultation : Intestinal sound (+) normal

Palpation : Tenderness (-), liver was palpable 5 cm belowarcus costae dextra

Percussion : Tympanic on all over the abdomen region

• Back : kyphosis (-), lordosis (-), scoliosis (-)

• Extremity :- Upper : edema (+/+) , cold acral (-/-)- Lower : edema (+/+) , cold acral (-/-)



18/4/2013 UNIT

Hb 10,6 g/dl

HCT 31 %

RBC 3,52 106/µl

WBC 9,8 103/µl

PLT 459 103 /µl

GDS 228 mg/dL

SGOT 18 u/l

SGPT 13 u/l

Albumin 2,6 g/dl

Ureum 142 mg/dL

Creatinin 2,1 mg/dL

Natrium 140 mmol/L

Kalium 5,6 mmol/L

Chlorida 116 mmol/L



Normal P wavePR interval 0,12 seconds

QRS complex 0,08 seconds

R-R regular, HR 130 bpmNormal T wavePoor R wave V1-4



CONCLUSIONLAH

Pulmonary edema withbilateral pleural efussion

CTR is difficult to be evaluatedApex is difficult to be evaluatedCardiophrenicus angle is difficult to beevaluatedCardiac waist disappearCostophrenic angle is blunt



• Anatomic : Peripartum cardiomyopathy•

Functional : CHF NYHA IV• Etiology : Cardiomyopathy• Comorbid : azotemia, hypoalbuminemia,hyperkalemia, hyperglikemia, anemia



• ICVCU• Half-sitting bedrest• O2 6 lt/mnt NRM•

Infus RL 10 cc/jam• Furosemid Inj loading dose 40 mg IV

followed by 20 mg/8 hours• Morphine Inj. 20 mg titration prn• Spironolakton 25 mg 1-0-0• ISDN 3 x 5 mg• Captopril 3x12,5 mg



• Fluid balance• Consult pulmonologist to manage the

bilateral pleural effusion• Echocardiography



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case report peripartum cardiomyopathy

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