[Incessant atrial tachycardia and peripartum cardiomyopathy--a therapeutic challenge].
Peripartum cardiomyopathy is an uncommon cause of heart failure but with serious prognosis. We report the case of a patient with peripartum cardiomyopathy presenting acute heart failure (severe biventricular systolic failure) and incessant atrial tachycardia, a rare arrhythmia difficult to control, that was responsible for cardiogenic shock, fetus death and multiple organ failure: renal failure (hemodialysis during 17 days), respiratory and hepatic failure and ischemic acute cholecystitis (treated surgically). After emergency cesarean section, heart rate control was obtained only after administering verapamil. Progressive clinical improvement with total recovery of hepatic and renal functions followed under treatment with vigorous multiple organ support. Six months after referral, the patients is doing well with normal daily life controlled with conventional therapy for heart failure, in stable sinus rhythm. Echocardiography shows a dilated left ventricle with partial resolution of systolic dysfunction rhythm. Echocardiography shows a dilated left ventricle with partial resolution of systolic dysfunction. The use of verapamil in severe biventricular systolic failure is discussed.
Brito
D
D
Unidade de Cuidados Intensivos Polivalentes, Hospital Universitário de Sta. Maria, Lisboa.
de Lacerda
A P
AP
Freitas
P
P
Costa e Silva
Z
Z
Bento
H
H
de Sousa
J
J
Fiuza
M
M
Lopes
M G
MG
Barbosa
M
M
França
C
C
D009202:Cardiomyopathies / Q000175:diagnosis* / Q000628:therapy; D002585:Cesarean Section; D003131:Combined Modality Therapy; D004630:Emergencies; D005260:Female; D005313:Fetal Death; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000628:therapy; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000628:therapy; D013612:Tachycardia, Ectopic Atrial / Q000175:diagnosis* / Q000628:therapy