title: Case of fulminant hepatic failure due to unrecognized peripartum cardiomyopathy.
abstract: OBJECTIVE
  To describe a postpartum patient who presented with fulminant hepatic failure and hepatic coma as a result of unrecognized peripartum cardiomyopathy.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Medical intensive care unit of a tertiary care academic medical center.
  
  
  METHODS
  A 35-yr-old woman 5 wks postpartum from an uneventful spontaneous vaginal delivery who was transferred to our institution with fulminant hepatic failure and worsening hepatic encephalopathy of unknown etiology for consideration of liver transplantation.
  
  
  METHODS
  An echocardiogram was obtained as part of an evaluation for refractory shock and the patient was found to have severe global hypokinesis with an ejection fraction of approximately 15%. She was diagnosed with peripartum cardiomyopathy and treatment with digoxin and afterload reduction was initiated.
  
  
  RESULTS
  After initiation of appropriate treatment for dilated cardiomyopathy, the patient's hepatic failure resolved and she made a full recovery.
  
  
  CONCLUSIONS
  Congestive heart failure is one of the few treatable causes of fulminant hepatic failure. Congestive heart failure must always be included in the differential diagnosis of fulminant hepatic failure of unknown pathogenesis.
authors.affiliation: Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Fussell
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Awad
authors.forename: Lorraine B
authors.initials: LB
authors.lastname: Ware
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000628:therapy; D002216:Captopril / Q000627:therapeutic use; D009202:Cardiomyopathies / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods; D003951:Diagnostic Errors; D004077:Digoxin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000628:therapy; D007022:Hypotension / Q000209:etiology / Q000628:therapy; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis* / Q000628:therapy; D006435:Renal Dialysis; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D002316:Cardiotonic Agents; D004077:Digoxin; D002216:Captopril