Peripartum cardiomyopathy is a rare life-threatening cardiac condition of unknown etiology that occurs in previously healthy women during the peripartum period and up to 5 months postpartum. Because of the rarity of the disorder, limited practical experience of most clinicians can lead to delayed diagnosis resulting in higher rates of complications and even death. Heightened suspicion of clinicians is imperative when patients present with signs and symptoms of heart failure, and utilization of multidisciplinary collaboration is essential to improve clinical outcomes.
A 30-year-old multiparous female at 38-week gestation, without significant medical history, presented to a suburban emergency room with complaints of sudden onset dyspnea, cough, and lower extremity edema. After evaluation and chest x-ray revealing pulmonary edema and cardiomegaly, the patient was transferred to a medical intensive care unit at a tertiary care center. On admission, the patient presented with tachycardia at 121 bpm, dyspnea with 36 breaths per minute, blood pressure 131/89, and SPO2 95% on 2 L nasal cannula. During the obstetric consultation, the patient was diagnosed with preeclampsia and transferred to labor and delivery for induction of labor and magnesium sulfate administration. During the course of induction, the patient continued to rapidly decompensate despite administration of Lasix, oxygen (O2), and unremarkable lab findings with SPO2 of 85% on 15 L O2, heart rate of 140, and respiratory rate of 40 with bilateral course crackles and stridor. Obstetric safety rounds were held including maternal fetal medicine, anesthesia, and obstetrics at which the nurse expressed concern regarding the patient's status and symptoms of cardiac failure. This led to escalation of care to include cardiology consults. Echocardiography revealed left systolic dilated dysfunction and an ejection fraction of 25% to 30%. The patient was diagnosed with peripartum cardiomyopathy, magnesium was discontinued, and additional Lasix administered. The patient had a spontaneous vaginal delivery and was immediately transferred to a cardiovascular intensive care unit (CVICU). In the CVICU she responded to treatment with BiPap, diuretics, nitrates, beta adrenergic blockers, and ACE inhibitors. She was discharged 5 days after delivery to be followed by outpatient cardiology.
It is essential for all clinicians to recognize early symptoms of cardiac failure in the pregnant patient. The establishment of multidisciplinary care and obstetric safety rounding is an essential element to expediting treatment and care of these patients. Nurses have a primary role in early assessment and participation in the multidisciplinary team approach to improving patient outcomes and expediting care. The situation, background, assessment, recommendation communication tool enables the bedside nurse to properly communicate patient status.