English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Plus monthly

Global: Zendy Tools annual

Global: Zendy Tools monthly

Global: Zendy Free Plan

482 (2 weeks). Due to the symptoms of heart failure in the postpartum period and the suspicion of peripartum cardiomyopathy (PPCM), treatment with bromocriptine was initiated (2.5 mg twice daily over 6 weeks). Because the symptoms of heart failure were still present, we administered levosimendan infusion, after which the patient’s condition significantly improved. Once her renal function stabilized, a chest computed tomogra‐ phy angiography (CTA) was performed, which confirmed thrombi in both ventricles, as well as pulmonary embolism, with right lower lobe in‐ farction (FIGURE 1E–1H). In addition, ultrasound ex‐ amination revealed thrombosis of the right inter‐ nal jugular, subclavian, and common iliac veins. On control TTE, we observed an improvement of the left ventricular EF and a significant reduc‐ tion of mitral and tricuspid valve regurgitation. The size of the thrombi in both ventricles was gradually reduced, until they resolved completely. The patient was hospitalized for 7 weeks and was discharged with an EF of 41%. The treatment recommendation involved rivaroxaban, carvedilol, with low doses of furosemide, spironolactone, and cilazapril. At 7 ‐month follow‐up, a control TTE showed an EF of 55%, with normal systolic pul‐ monary artery pressure. In 2010, the Working Group on PPCM of the European Society of Cardiology defined PPCM as “an idiopathic cardiomyopathy presenting with HF [heart failure] secondary to left ventricular (LV) systolic dysfunction towards the end of preg‐ nancy or in the months following delivery, where A 27 ‐year ‐old woman was admitted to the inten‐ sive cardiac care unit with advanced heart failure and generalized edema. The patient was 2 months after labor by cesarean section. It was her second pregnancy; the first pregnancy was extrauterine 2 years earlier. She did not have any other known risk factors for peripartum cardiomyopathy and pulmonary embolism. Laboratory tests revealed renal and hepatic failure, elevated D ‐dimer lev‐ els (103 457 ng/ml), and significantly increased levels of inflammatory markers. Transthoracic echocardiography (TTE) on admission showed thrombosis in both ventricles, an ejection frac‐ tion (EF) of 23%, a left ventricular end ‐diastolic diameter of 4.5 cm, a right ventricular diame‐ ter of 2.1 cm (body surface area, 1.2 m2), tricus‐ pid annulus plane systolic excursion (TAPSE) of 12 mm, and second to third degree mitral and tricuspid valve regurgitation, with a tricuspid valve regurgitation velocity of 355 cm/s, accom‐ panied by pericardial fluid and pleural effusion (FIGURE 1A–1D). Chest X ‐ray showed pleural effu‐ sion in both cavities with possible inflammatory lesions in the right lower lobe area. Treatment with unfractionated heparin was initiated, followed by administration of low‐ ‐molecular ‐weight heparin, furosemide, dopa‐ mine and dobutamine infusions, and supple‐ mentary oxygen. Alternative treatment options were also considered, including the administra‐ tion of alteplase and thrombectomy, considering the high risk of thrombolysis, multiorgan failure, and the time elapsed from the onset of symptoms CLINICAL IMAGE

polskie archiwum medycyny wewnętrznej

Diagnostic and therapeutic difficulties in a patient with peripartum cardiomyopa-thy with advanced heart failure, complicated by thrombus in both ventricles and pulmonary embolism, with right lower lobe infarction