Case of the Week: 28 Jan

January 28, 2019

A possible case of Postpartum Cardiomyopathy:

We had been looking after a 2 month-old baby with pneumonia on the paediatric ward when it came to our attention that the new mother was not so well. It was 2 months after she delivered her twin daughters by C-section. She told us that the delivery was quite traumatic and she had lost a lot of blood. Now she was mainly being troubled by severe headaches, tiredness and shortness of breath.

She was previously well, with no medical problems. Her pregnancy had also been uncomplicated, with no known problems with blood pressure. We examined her and found that at this time blood pressure was raised at 180/110 and a murmur was heard when listening to her heart. 

In discussion with the team there was concern that this may be postpartum cardiomyopathy. This is a form of heart failure where the heart chambers enlarge and the muscle weakens. As a result there is less blood flow and the heart cannot meet the demands of the body’s organs. The cause of this is unclear, however it is more common in woman of African ethnicity. This may be due to genetics, exposure to certain viral illnesses, poor nutrition or abnormal immune responses.

We investigated this patient further at Kivunge with simple blood tests, which showed that she was not anaemic and her renal function was ok. However her cholesterol was raised. Reassuringly her chest xray showed that her heart size was normal and there was no fluid in the lungs. We successfully treated her raised blood pressure with antihypertensives and also started a statin to lower her cholesterol. She felt much better following this and her 2 month-old daughter was also ready for discharge. We advised her to attend Mnazi Moja Hospital in the capital of the island for further investigations including an ECG and Echo (ultrasound scan showing the heart function). She will also be followed up at the hypertension clinic at Kivunge to see how she gets on.

This case served as a reminder to us when looking after newborns, of how important it is to check the mother is well. They may have little follow up or support following a delivery, and they are at risk of several medical conditions such as anaemia, infections and malnutrition. Early detection of these issues can prevent maternal deaths. Mothers play a key role in the recovery of their baby and therefore we must support this by actively protecting their health.  

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