PDF(Pubmed)
Abstract：
BACKGROUND: Peripartum cardiomyopathy (PPCM) is a potentially life-threatening pregnancy-related condition characterized by left ventricular dysfunction and heart failure, typically occurring in the peripartum period. Individuals with a history of preeclampsia and hypertension are particularly prone to developing PPCM. Recent research suggests that the condition may be triggered by vascular dysfunction influenced by maternal hormones in the late stages of gestation. The onset of left heart failure results in decreased cardiac output, leading to insufficient perfusion, which in turn, contributes to pulmonary edema and exacerbates tissue hypoxia. This cardiovascular response activates the neurohumoral system, causing peripheral vasoconstriction and elevating both mean capillary filling pressure (MCFP) and central venous pressure (CVP). Early administration of furosemide reduces volume overload due to negative cumulative fluid balance gaining and vasodilation, which increases the velocity of intravascular refilling and causes interstitial edema to resolve. This will decrease interstitial fluid pressure, resulting in decreased mechanical compression to systemic capillary and systemic vein pressure, thus decreasing MCFP and CVP subsequently. Reduced CVP also contributes to increased venous return by decreasing the gradient pressure between MCFP and CVP, resulting in increased cardiac output (CO) and improved tissue oxygenation.
METHODS: A 33-year-old Asian woman, para 3 at full term pregnancy, admitted to the intensive care unit (ICU) after c-section and tubectomy due to shortness of breath and palpitation. Based on history taking, physical examination and echocardiography the patient fulfilled the criteria of PPCM which was also complicated by pulmonary edema. Despite impending respiratory failure, the patient rejected intubation and continuous positive airway pressure (CPAP), and was given oxygen supplementation through nasal cannula. Furosemide was given rapidly continued by maintenance dose and CVP was monitored. Antihypertensive drug, anticoagulants, and bromocriptine were also administered. After achieving negative cumulative fluid balance the patient\'s symptoms resolved and was discharged one week later.
CONCLUSIONS: There is a correlation between negative cumulative fluid balance and reduced central venous pressure after early furosemide therapy. Suspicion for PPCM should not be lowered in the presence of preeclampsia, it could delay appropriate treatment and increase the mortality.
METHODS: A 33-year-old Asian woman, para 3 at full term pregnancy, admitted to the intensive care unit (ICU) after c-section and tubectomy due to shortness of breath and palpitation. Based on history taking, physical examination and echocardiography the patient fulfilled the criteria of PPCM which was also complicated by pulmonary edema. Despite impending respiratory failure, the patient rejected intubation and continuous positive airway pressure (CPAP), and was given oxygen supplementation through nasal cannula. Furosemide was given rapidly continued by maintenance dose and CVP was monitored. Antihypertensive drug, anticoagulants, and bromocriptine were also administered. After achieving negative cumulative fluid balance the patient\'s symptoms resolved and was discharged one week later.
CONCLUSIONS: There is a correlation between negative cumulative fluid balance and reduced central venous pressure after early furosemide therapy. Suspicion for PPCM should not be lowered in the presence of preeclampsia, it could delay appropriate treatment and increase the mortality.
摘要：
背景：围产期心肌病（PPCM）是一种潜在的危及生命的妊娠相关疾病，其特征是左心室功能障碍和心力衰竭，通常发生在围产期。具有先兆子痫和高血压病史的个体特别容易发生PPCM。最近的研究表明，这种情况可能是由妊娠晚期母体激素影响的血管功能障碍引起的。左心衰竭的发作导致心输出量下降，导致灌注不足，反过来，导致肺水肿并加剧组织缺氧。这种心血管反应激活了神经体液系统，引起外周血管收缩并升高平均毛细血管充盈压（MCFP）和中心静脉压（CVP）。呋塞米的早期给药减少了由于负的累积液体平衡增加和血管舒张引起的容量超负荷。这增加了血管内再填充的速度，并导致间质水肿消退。这将降低间质液压力，导致全身毛细血管和全身静脉压的机械压缩减少，从而降低MCFP和CVP。降低的CVP还有助于通过降低MCFP和CVP之间的梯度压力来增加静脉回流。导致心输出量（CO）增加和组织氧合改善。
方法：一位33岁的亚洲女性，第3段在足月怀孕时，由于呼吸急促和心悸，在剖腹产和输卵管切除术后进入重症监护病房（ICU）。根据历史，体格检查和超声心动图检查，患者符合PPCM的标准，PPCM也并发肺水肿。尽管即将出现呼吸衰竭,患者拒绝插管和持续气道正压通气（CPAP），并通过鼻插管补充氧气。通过维持剂量快速持续给予呋塞米，并监测CVP。抗高血压药物，抗凝剂,和溴隐亭也给药。在达到阴性累积液体平衡后，患者的症状得到缓解，一周后出院。
结论：早期呋塞米治疗后，负累积液体平衡与中心静脉压降低之间存在相关性。在先兆子痫的情况下，不应降低对PPCM的怀疑，它可能会延迟适当的治疗和增加死亡率。
方法：一位33岁的亚洲女性，第3段在足月怀孕时，由于呼吸急促和心悸，在剖腹产和输卵管切除术后进入重症监护病房（ICU）。根据历史，体格检查和超声心动图检查，患者符合PPCM的标准，PPCM也并发肺水肿。尽管即将出现呼吸衰竭,患者拒绝插管和持续气道正压通气（CPAP），并通过鼻插管补充氧气。通过维持剂量快速持续给予呋塞米，并监测CVP。抗高血压药物，抗凝剂,和溴隐亭也给药。在达到阴性累积液体平衡后，患者的症状得到缓解，一周后出院。
结论：早期呋塞米治疗后，负累积液体平衡与中心静脉压降低之间存在相关性。在先兆子痫的情况下，不应降低对PPCM的怀疑，它可能会延迟适当的治疗和增加死亡率。
