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Abstract：
This case report highlights the rare occurrence of postpartum psychosis in the setting of peripartum cardiomyopathy, which can have rare presentations like arrhythmias and pulmonary edema; and the challenges one should anticipate while managing these conditions together. Caution is advised whenever antipsychotic drugs are to be administered to a patient with a cardiac condition as these drugs potentially increase the risk of arrhythmias and sudden death.
A 35 year old grand multiparous woman who was 1 week into puerperium was admitted with severe difficulty in breathing at rest, chest congestion and pain. She also had easy fatigability, orthopnea, paroxysmal nocturnal dyspnea, edema, tachycardia, tachypnea, irregularly irregular heart rate with a pulse deficit, elevated jugular venous pressure, cardiomegaly, hepatomegaly and pulmonary crepitations. On the sixth day while improving on standard drugs for heart failure, she developed bizarre behavior and confusion. She also had auditory, visual and olfactory hallucinations; violence to the baby and the husband; and refusal to feed and take medication. There was no altered sensorium and the vital signs were normal. She was diagnosed with puerperal psychosis during the management of peripartum cardiomyopathy.
In the rare occurrence of puerperal psychosis in the course of management of peripartum cardiomyopathy one must be acutely aware of the risk of sudden cardiac death occasioned by use of antipsychotics, either directly or due to arrhythmias. Continuous electrocardiogram (ECG) monitoring or use of alternative management modalities is thus highly advised.
A 35 year old grand multiparous woman who was 1 week into puerperium was admitted with severe difficulty in breathing at rest, chest congestion and pain. She also had easy fatigability, orthopnea, paroxysmal nocturnal dyspnea, edema, tachycardia, tachypnea, irregularly irregular heart rate with a pulse deficit, elevated jugular venous pressure, cardiomegaly, hepatomegaly and pulmonary crepitations. On the sixth day while improving on standard drugs for heart failure, she developed bizarre behavior and confusion. She also had auditory, visual and olfactory hallucinations; violence to the baby and the husband; and refusal to feed and take medication. There was no altered sensorium and the vital signs were normal. She was diagnosed with puerperal psychosis during the management of peripartum cardiomyopathy.
In the rare occurrence of puerperal psychosis in the course of management of peripartum cardiomyopathy one must be acutely aware of the risk of sudden cardiac death occasioned by use of antipsychotics, either directly or due to arrhythmias. Continuous electrocardiogram (ECG) monitoring or use of alternative management modalities is thus highly advised.
摘要：
该病例报告强调了在围产期心肌病的背景下产后精神病的罕见发生，这可能有罕见的表现，如心律失常和肺水肿；以及在共同管理这些疾病时应该预料到的挑战。对于患有心脏病的患者，建议谨慎使用抗精神病药物，因为这些药物可能会增加心律失常和猝死的风险。
一名35岁的经产妇女进入产褥期1周，因休息时呼吸严重困难而入院。胸部充血和疼痛。她也容易疲劳，端坐呼吸,阵发性夜间呼吸困难，水肿,心动过速,呼吸急促,不规则的心率与脉搏不足，颈静脉压升高,心脏肿大,肝肿大和肺隆起。第六天，在改善心力衰竭标准药物的同时，她产生了奇怪的行为和困惑。她也有听觉,视觉和嗅觉幻觉；对婴儿和丈夫的暴力行为；拒绝进食和服药。感觉没有改变，生命体征正常。在围产期心肌病的治疗期间，她被诊断出患有产褥期精神病。
在处理围产期心肌病的过程中，在罕见的产褥期精神病中，人们必须敏锐地意识到使用抗精神病药引起的心源性猝死的风险，直接或由于心律失常。因此，强烈建议进行连续心电图（ECG）监测或使用替代管理方式。
一名35岁的经产妇女进入产褥期1周，因休息时呼吸严重困难而入院。胸部充血和疼痛。她也容易疲劳，端坐呼吸,阵发性夜间呼吸困难，水肿,心动过速,呼吸急促,不规则的心率与脉搏不足，颈静脉压升高,心脏肿大,肝肿大和肺隆起。第六天，在改善心力衰竭标准药物的同时，她产生了奇怪的行为和困惑。她也有听觉,视觉和嗅觉幻觉；对婴儿和丈夫的暴力行为；拒绝进食和服药。感觉没有改变，生命体征正常。在围产期心肌病的治疗期间，她被诊断出患有产褥期精神病。
在处理围产期心肌病的过程中，在罕见的产褥期精神病中，人们必须敏锐地意识到使用抗精神病药引起的心源性猝死的风险，直接或由于心律失常。因此，强烈建议进行连续心电图（ECG）监测或使用替代管理方式。
