Kosin Med J.  2017 Dec;32(2):244-250. 10.7180/kmj.2017.32.2.244.

Recurrent fetal postpartum stress induced cardiomyopathy after normal vaginal delivery

• Noh YS
• Her SH
• Kwon JB
• Kim CJ
• Kim TS

• KMID: 2400269
• DOI: http://doi.org/10.7180/kmj.2017.32.2.244

Abstract

Stress induced cardiomyopathy is a disease that shows a dysfunction of the ventricle, but it can be rapidly reversible. It often occurs in older women primarily who suffers from emotional or physical stress. There are some case reports about postpartum stress induced cardiomyopathy. Most of the patients are recovered naturally within days to weeks. We report a case of a 37 years-old woman, who had experienced postpartum stress induced cardiomyopathy 8 years ago, revisited hospital because of cardiomyopathy after secondary delivery. Herein we report a rare case of recurrent stress induced cardiomyopathy after secondary normal vaginal delivery.

Keyword

Postpartum; Recurrence; Stress induced cardiomyopathy

MeSH Terms

Cardiomyopathies*
Female
Humans
Postpartum Period*
Recurrence

Figure

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  Fig. 1 ECG Electrocardiogram in the EMS ambulance after first normal vaginal delivery on September 22th 2005. The ventricular fibrillation (A) was conversed to regular sinus rhythm after defibrillation (B). EMS: emergency medical service.

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  Fig. 2 Echocardiography was showed that increased dimension and volume of LV after second normal vaginal delivery. A: LVEDD (LV end diastolic dimension) of LV basal level at parasternal view (M-mode) was 45mm before second normal vaginal delivery. B: LVEDD (LV end diastolic dimension) of LV mid-portion at parasternal view (M-mode) was 45mm before second normal vaginal delivery. C: LVEDV (LV end diastolic volume) was 82.7ml at apical 4 chamber view before second normal vaginal delivery. D: LVEDD (LV end diastolic dimension) of LV basal level at parasternal view (M-mode) was 50mm on the 12 days after second normal vaginal delivery. E: LVEDD (LV end diastolic dimension) of LV mid-portion at parasternal view (M-mode) was 53mm on the 12 days after second normal vaginal delivery. F: LVEDV (LV end diastolic volume) was 107.4ml at apical 4 chamber view on the 12 days after second normal vaginal delivery.

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  Fig. 3 ECG The twelve-lead electrocardiogram shows ST-segment depression in the I, II, aVL, aVF, V3–6 leads

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  Fig. 4 ECG The twelve-lead electrocardiogram is normalized after improvement of symptoms.

Reference

1. Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J. 2008; 155:408–417.

2. Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005; 352:539–548.

3. Jo YY, Park S, Choi YS. Extracorporeal membrane oxygenation in a patient with stress-induced cardiomyopathy after caesarean section. Anaesth Intensive Care. 2011; 39:954–957.

4. Gianni M, Dentali F, Grandi AM, Sumner G, Hiralal R, Lonn E. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J. 2006; 27:1523–1529.

5. Jeong H, Lee S, Jeong C, Lee J, Jeong S, Chung S, et al. Inverted Takotsubo-Like Left Ventricular Dysfunction with Pulmonary Oedema Developed after Caesarean Delivery Complicated by Massive Haemorrhage in a Severe Preeclamptic Parturient with a Prolonged Painful Labour. Case Rep Anesthesiol. 2011; 2011:164720.

6. Ghadri JR, Ruschitzka F, Lüscher TF, Templin C. Takotsubo cardiomyopathy: still much more to learn. Heart. 2014; 100:1804–1812.

7. Caforio AL1, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013; 34:2636–2648.

8. Redfors B, Shao Y, Omerovic E. Stress-induced cardiomyopathy (Takotsubo)--broken heart and mind? Vasc Health Risk Manag. 2013; 9:149–154.

9. Citro R, Pascotto M, Provenza G, Gregorio G, Bossone E. Transient left ventricular ballooning (tako-tsubo cardiomyopathy) soon after intravenous ergonovine injection following caesarean delivery. Int J Cardiol. 2010; 138:e31–e34.

10. Enderton Elizabeth L, Cardwell Michael S. Postpartum takotsubo cardiomyopathy with reversible cerebral vasoconstriction syndrome: a case report. Case Rep Perinat Med. 2013; 2:21–24.

11. Lee PH, Song JK, Sun BJ, Choi HO, Seo JS, Na JO, et al. Outcomes of patients with stress-induced cardiomyopathy diagnosed by echocardiography in a tertiary referral hospital. J Am Soc Echocardiogr. 2010; 23:766–771. Figure.