RESUMO
BACKGROUND AND AIMS: The epidemiology of peripartum cardiomyopathy (PPCM) in Europe is poorly understood and data on long-term outcomes are lacking. A retrospective, observational, population-level study of validated cases of PPCM in Scotland from 1998 to 2017 was conducted. METHODS: Women hospitalized with presumed de novo left ventricular systolic dysfunction around the time of pregnancy and no clear alternative cause were included. Each case was matched to 10 controls. Incidence and risk factors were identified. Morbidity and mortality were examined in mothers and children. RESULTS: The incidence of PPCM was 1 in 4950 deliveries. Among 225 women with PPCM, obesity, gestational hypertensive disorders, and multi-gestation were found to be associated with having the condition. Over a median of 8.3 years (9.7 years for echocardiographic outcomes), 8% of women with PPCM died and 75% were rehospitalized for any cause at least once. Mortality and rehospitalization rates in women with PPCM were â¼12- and â¼3-times that of controls, respectively. The composite of all-cause death, mechanical circulatory support, or cardiac transplantation occurred in 14%. LV recovery occurred in 76% and, of those who recovered, 13% went on to have a decline in LV systolic function despite initial recovery. The mortality rate for children born to women with PPCM was â¼5-times that of children born to controls and they had an â¼3-times greater incidence of cardiovascular disease over a median of 8.8 years. CONCLUSIONS: PPCM affected 1 in 4950 women around the time of pregnancy. The condition is associated with considerable morbidity and mortality for the mother and child. There should be a low threshold for investigating at-risk women. Long term follow-up, despite apparent recovery, should be considered.
Assuntos
Cardiomiopatias , Complicações Cardiovasculares na Gravidez , Disfunção Ventricular Esquerda , Gravidez , Criança , Feminino , Humanos , Estudos Retrospectivos , Período Periparto , Ecocardiografia , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/etiologiaAssuntos
Serviços Médicos de Emergência/organização & administração , Infarto do Miocárdio/tratamento farmacológico , Terapia Trombolítica/métodos , Eletrocardiografia , Emergências , Humanos , Relações Interprofissionais , Equipe de Assistência ao Paciente/organização & administração , Transporte de PacientesRESUMO
This case study reviews the history, symptoms, management and rehabilitation of a patient admitted to accident and emergency with severe chest pain. After other conditions had been ruled out he was diagnosed with acute non-ST-elevation myocardial infarction. He later underwent a coronary angioplasty.
