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Case Report
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Birinci basamakta bir Peripartum Kardiyomiyopati vakası

Year 2016, Volume: 1 Issue: 3, 73 - 75, 12.01.2017

Burkay Yakar Yusuf Haydar Ertekin , Yasemin Korkut

https://doi.org/10.22391/920.287413

Abstract

Giriş:  Peripartum Kardiyomiyopati (PKM), gebeliğin son ayında ve doğumdan sonraki ilk 5 ay içerisinde, kalp genişlemesi ve kalp kasının zayıflaması sonucu ortaya çıkan konjestif kalp yetmezliği formudur.  Otuz yaş ve üzeri gebelik, multiparite, kronik hipertansiyon ve eklampsi PKM gelişiminde önemli risk faktörleridir.  Nefes darlığı, çarpıntı, halsizlik, alt extremitede ödem gibi hastalığın erken belirtileri, gebeliğin son dönemlerinde normal karşılaşılabilecek sorunlar olduğundan kalp yetmezliğinden ayırt edilemeyip erken tanı gözden kaçabilmektedir.  PKM tanısı anamnez, fizik muayene ve ekokardiyografi ile konur.

Vaka Sunumu: Otuzdört yaşındaki kadın hasta, bir aylık bebeğinin aşısını yaptırmak için aile hekimliği polikliniğimize müracaat etti. Hastanın nefes darlığı, çarpıntı ve öksürük şikayeti mevcuttu.  Özgeçmişinden iki sağlıklı doğum yaptığı, soygeçmişinde ise annesinin Primer Hipertansiyon ve Tip 2 Diyabet hastası olduğu öğrenildi.  Gebeliklerinde ve öncesinde herhangi bir hastalık veya ilaç kullanım öyküsü yoktu.  Fizik muayenesinde kan basıncı 120/70mmHg, nabzı ritmik ve 122/dakika, kalp seslerinde üfürümü yok, her iki akciğer bazallerde ralleri mevcut, batın muayenesi doğal saptandı.  Her iki alt ekstremitede ise gode bırakan ödemi mevcuttu.  Anamnez derinleştirildiğinde çarpıntısının doğumdan iki hafta önce başladığı ve postpartum birinci haftada artış gösterdiği öğrenildi.  Kalp yetmezliği ve pulmoner emboli ön tanıları düşünülerek kardiyoloji uzmanına sevk edilen hasta akut dekompanse kalp yetmezliği tanısıyla yoğun bakıma yatırılarak tedavi edildi.

Sonuç: PKM gebelikte sık karşılaşılan çarpıntı ve nefes darlığı şikayetlerinin nonspesifik olması sebebiyle erken tanısı güç bir hastalıktır.  Hastalığın 30 yaş üzeri annelerde daha sık ortaya çıkması ve günümüzde anne olma yaşının ileri yaşlara gelmesi sebebiyle birinci basamakta PKM’yle karşılaşma olasılığı artmaktadır.  Aile hekimleri düşük prevalansta görülen bu hastalığın risk faktörlerini sorgulama, semptomlarını takip etme ve uzmanına danışma yöntemleriyle üstesinden gelebilir.

Keywords

Aile hekimliği gebelik kardiyomiyopati peripartum dönem postpartum dönem

References

  • Peripartum Cardiomyopathy Michael M. Givertz, MD Circulation. 2013;127:e622-e626.) © 2013 American Heart Association, Inc. DOI: 10.1161/CIRCULATIONAHA.113.001851
  • Peripartum Cardiomyopathy Ümran Koçak, Derya Tok, Göktürk İpek Abant Medical Journal Volume Cilt 2 Issue Sayı 2 Year Yıl 2013 doi: 10.5505/abantmedj.2013.26818
  • Journal of the American College of Cardiology Vol. 58, No. 7, 2011 (no:4)
  • Peripartum Cardiomyopathy VN Mishra, Nalini Mishra, Devanshi : JAPI April 2013 Vol:61
  • Demakis JG, rahimtoola SH; Peripartum Cardiomyopathy. Circulation 1971;44;964-68.
  • Witlin AG, Mabie WC, Sibai BM. Peripartum cardiomypathy: an omnious diagnosis. Am j Obstet Gynecol 2008;199: e5-6
  • Mielniczuk LM, Williams L, Davis DR, et al. Frequency of peripartum cardiomyopathy. Am J Cardiol 2006;97:1765-8
  • Amos A, Jaber WA, Russel SD. Improved outcomes in peripartum cardiomyopathy with contemporary. Am Heart J 2006;152:509-13
  • Goland S, Modi K, Bitar F, et al. Clinical profile and predictors ofcomplications in peripartum cardiomyopathy. J Card Fail 2009;15: 645–50.
  • Groesdonk HV, Dinse- Lambracht A, Doblanzki W, Doblanzki U,Galm C, Muth C-M. Unrecognized peripartum cardiomyopathy,case series and comprehensive review of literature. Appl Cardiopulm Pathophysiol 2009;13:237– 42.
  • Kaaja R. Peripartum cardiomyopathy. Minerva Cardioangiol 2006; 543: 331–6.
  • Person GD, Veille JC, Rahimtoola S. et al. Peripartum cardiomyopathy: National Heart,Lung and Blood Institute and Office of Rare Diseases (National Instutes of Health) workshop recommendations and review. JAMA 2000;283:1183-8

A case of peripartum cardiomyopathy in primary care

Year 2016, Volume: 1 Issue: 3, 73 - 75, 12.01.2017

Burkay Yakar Yusuf Haydar Ertekin , Yasemin Korkut

https://doi.org/10.22391/920.287413

Abstract

Introduction:  Peripartum cardiomyopathy (PKM) is a form of congestive heart failure that results from an enlarging of the heart and a weakening of the heart muscle in the last month of pregnancy and in the first five months of the postnatal period.   Major risk factors include pregnancy at >30 years of age, multiparity, chronic hypertension and eclampsia.   Patients suffering from PKM generally present with symptoms akin to heart failure, and the condition can be considered normal during the late period of pregnancy.  A diagnosis of PKM can be made from anamnesis, a physical examination and echocardiography.

Case Presentation:  A 34-year old female patient, visiting the family medicine polyclinic for vaccinations of her 1-month-old infant, was noted to be suffering from shortness of breath, palpitations and coughing.  There was no medical history of any disease or medication before or during the pregnancy.  The patient’s blood pressure was 120/70 mmHg and her pulse was rhythmic at 122/min.  There was no cardiac murmur, rales were present in both pulmonary bases and the results of an abdominal examination were normal.  Pitting edemas were observed in both lower extremities, and a further anamnesis revealed that the patient’s palpitations had begun two weeks prior to the birth, and had increased in the first postpartum week.  The patient was transferred to a cardiologist due to concerns of heart failure and a pulmonary embolism, and was then admitted to the intensive care unit for treatment with a diagnosis of acute decompensated heart failure.

Conclusion:  Given the higher incidence of disease in mothers >30 years, and the advanced average age of maternity in the present day, the odds of encountering PKM in the primary care is increasing.  Family physicians can overcome this low-prevalence of the disease by investigating risk factors, following-up symptoms and consulting experts.

Keywords

Family physicians pregnancy cardiomyopathies peripartum period postpartum period

References

  • Peripartum Cardiomyopathy Michael M. Givertz, MD Circulation. 2013;127:e622-e626.) © 2013 American Heart Association, Inc. DOI: 10.1161/CIRCULATIONAHA.113.001851
  • Peripartum Cardiomyopathy Ümran Koçak, Derya Tok, Göktürk İpek Abant Medical Journal Volume Cilt 2 Issue Sayı 2 Year Yıl 2013 doi: 10.5505/abantmedj.2013.26818
  • Journal of the American College of Cardiology Vol. 58, No. 7, 2011 (no:4)
  • Peripartum Cardiomyopathy VN Mishra, Nalini Mishra, Devanshi : JAPI April 2013 Vol:61
  • Demakis JG, rahimtoola SH; Peripartum Cardiomyopathy. Circulation 1971;44;964-68.
  • Witlin AG, Mabie WC, Sibai BM. Peripartum cardiomypathy: an omnious diagnosis. Am j Obstet Gynecol 2008;199: e5-6
  • Mielniczuk LM, Williams L, Davis DR, et al. Frequency of peripartum cardiomyopathy. Am J Cardiol 2006;97:1765-8
  • Amos A, Jaber WA, Russel SD. Improved outcomes in peripartum cardiomyopathy with contemporary. Am Heart J 2006;152:509-13
  • Goland S, Modi K, Bitar F, et al. Clinical profile and predictors ofcomplications in peripartum cardiomyopathy. J Card Fail 2009;15: 645–50.
  • Groesdonk HV, Dinse- Lambracht A, Doblanzki W, Doblanzki U,Galm C, Muth C-M. Unrecognized peripartum cardiomyopathy,case series and comprehensive review of literature. Appl Cardiopulm Pathophysiol 2009;13:237– 42.
  • Kaaja R. Peripartum cardiomyopathy. Minerva Cardioangiol 2006; 543: 331–6.
  • Person GD, Veille JC, Rahimtoola S. et al. Peripartum cardiomyopathy: National Heart,Lung and Blood Institute and Office of Rare Diseases (National Instutes of Health) workshop recommendations and review. JAMA 2000;283:1183-8
There are 12 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Case Report
Authors

Burkay Yakar

Yusuf Haydar Ertekin

Yasemin Korkut

Publication Date January 12, 2017
Submission Date June 1, 2016
Acceptance Date December 12, 2016
Published in Issue Year 2016 Volume: 1 Issue: 3

Cite

APA Yakar, B., Ertekin, Y. H., & Korkut, Y. (2017). A case of peripartum cardiomyopathy in primary care. Family Practice and Palliative Care, 1(3), 73-75. https://doi.org/10.22391/920.287413
AMA Yakar B, Ertekin YH, Korkut Y. A case of peripartum cardiomyopathy in primary care. Fam Pract Palliat Care. January 2017;1(3):73-75. doi:10.22391/920.287413
Chicago Yakar, Burkay, Yusuf Haydar Ertekin, and Yasemin Korkut. “A Case of Peripartum Cardiomyopathy in Primary Care”. Family Practice and Palliative Care 1, no. 3 (January 2017): 73-75. https://doi.org/10.22391/920.287413.
EndNote Yakar B, Ertekin YH, Korkut Y (January 1, 2017) A case of peripartum cardiomyopathy in primary care. Family Practice and Palliative Care 1 3 73–75.
IEEE B. Yakar, Y. H. Ertekin, and Y. Korkut, “A case of peripartum cardiomyopathy in primary care”, Fam Pract Palliat Care, vol. 1, no. 3, pp. 73–75, 2017, doi: 10.22391/920.287413.
ISNAD Yakar, Burkay et al. “A Case of Peripartum Cardiomyopathy in Primary Care”. Family Practice and Palliative Care 1/3 (January2017), 73-75. https://doi.org/10.22391/920.287413.
JAMA Yakar B, Ertekin YH, Korkut Y. A case of peripartum cardiomyopathy in primary care. Fam Pract Palliat Care. 2017;1:73–75.
MLA Yakar, Burkay et al. “A Case of Peripartum Cardiomyopathy in Primary Care”. Family Practice and Palliative Care, vol. 1, no. 3, 2017, pp. 73-75, doi:10.22391/920.287413.
Vancouver Yakar B, Ertekin YH, Korkut Y. A case of peripartum cardiomyopathy in primary care. Fam Pract Palliat Care. 2017;1(3):73-5.
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Family Practice and Palliative Care       ISSN 2458-8865       E-ISSN 2459-1505