LAPORAN

KASUS
KARDIOMIOPAT
I PERIPARTUM
OLEH : DR. RAJIV ABDULLAH BIN HATIM

PEMBIMBING : KOL.ONEL CKM DR HADI

DJUANDA SP.PD
PENDAMPING : DR YEMIMA D KARUBABA

RUMAH SAKIT MARTHEN INDEY

PROGRAM INTERNSHIP DOKTER INDONESIA
JAYAPURA-PAPUA
2021
CASE REPORT

 IDENTITAS PASIEN
 Anamnesis
 Nama lengkap : Ny. A
 Keluhan Utama : Demam
 Tanggal lahir : 10/03/1989
 RPS : Demam sejak 2 hari disertai batuk
 Umur : 32th kering, nyeri menelan, sesak, pasien hamil anak ke 2
 MRS : 06/09/2021 usia kehamilan 9 bulan. Riwayat kontak dengan
pasien positif covid19(+)
 Alamat : Doyo Baru
CASE REPORT

 PEMERIKSAAN FISIK  PEMERIKSAAN PENUNJANG

 KU : tampak sakit sedang  DL (6/9/21)
 TTV  hb : 11.1
 TD: 130/70 HR : 81x/m RR: 22x/m t: 36.9C SpO2: 98%  Rbc : 4.01 x 106
 TFU : 33cm  Mcv : 80,5
 DJJ : 146x/m  Mchc : 34.4
 WBC : 4.840
 NEUT : 79.6
 EO : 0.0
 LYMPH :15.7
 MONO: 4.5

 PLT : 155000
 DDR : negative
CASE REPORT

 PEMERIKSAAN PENUNJANG
CASE REPORT
CASE REPORT

 ASSESMENT  Treatment
 G2P1A0 aterm dengan penyulit pneumonia, susp  MRS
Covid-19
 IVFD RL 500cc 20 tpm
 Inj. Dexametasone 2x1 amp
 Drip PCT 3x1000mg
 Inj. Ondansetron 3x 1 amp
CASE REPORT

 Follow up (7/9/21)  Follow up (10/9/21)

 S: batuk, demam(-)  S : sesak
 O: TD 89/67 HR: 72 S: 35,6 DJJ: 110x USG:  O : TD: 130/90 HR: 60x/m RR: 28x/m SPO2: 90%
oligohidramnion  Rh+/+ wh+/+ Kardiomegali+ Edema +/+
 A: G2P1A0 uk 38 minggu THIU+ Fetal distress
 A: Kardiomiopati post partum
 P : Pro SC cito
 P: posisi ½ duduk

O2 sungkup 8lpm/jam
RL 500cc/24jam
Furosemide 2x 3 amp IV
Captopril 3x6,25mg
CASE REPORT
CASE REPORT

 Treatment
 Follow up (12/9/2021)
 IVFD NaCl 0,9% 500cc/24jam
 B1: pasien bernapas menggunakan NRM 8-10lpm
 Resfar 1x 5000mg
sesak(+) SPO2 90%
 Levofloxacin 1x 750mg
 B2: 85/59
 Dexametason 1x2 amp
 B3: GCS 456  Vit c 1x 1000mg
 B4: dbn  Furosemide 2x 3 amp

 B5: dbn  Paracetamo 3x500mg prn

 B6: dbn  Favivirapiravir 2x3tab (hari ke 3)

 Sancoidan 3 x1 caps
 A: peripartum cardiomyopathy + post Covid19
 Cetirizine 2 x 10mg
 Captopril 2x12,5mg
 Pronalges sup 3x1 prn
CASE REPORT
CASE REPORT
CASE REPORT

 Follow up(14/9/2021)  S: Sesak+

 S: sesak+  O: TD : 123/82 HR: 115 RR : 28x/m SPO2: 88-89%
 O: TD:124/74mmhg HR: 125x/m RR: 28x/m SpO2: 90%  A: pneumonia
 A: CHF  P: meropenem 3x1gr
 Kardiomiopati peripartum  ceftazidine 3x1gr
 P: IVFD RL 500cc/24jam
 combivent / 12jam
Omeprazole 2x1 amp
 dexametason 1x1 amp
furosemide 2x3 amp IV
 vestein 3x1
Meropenem 3x1 gr
 cetirizine 2x10mg
Captopril 3x12,5mg
Bisoprolol 1x 5mg
 Sancoidin 3x1

Sucralfat syr 3x2 cth

 Becomzet 1x1
PERIPARTUM CARDIOMYOPATHY
INTRODUCTION
 Peripartum cardiomyopathy is a unusual form of dilated cardiomyopathy of unknown
etiology.
 Occurs in previously healthy women in the final months of pregnancy & upto 5
months after delivery.
 (0.1% of pregnancies) can lead to devasting consequences with overall morbidity
mortality rates as high as 5 to 32%
ETIOLOGY:

 Cardiovascular stress of pregnancy(increased fluid load)

 Inflammatory response in pregnancy- elevation of TNF alpha&IL-6
 Pathologic autoimmune response to fetal cells that lodge in the maternal circulation &
cardiac tissue.
 Nutritional deficiencies-selenium
PATHOPHYSIOLOGY
 PATHOGENESIS
Genetic Factors
Twin Pregnancy
Stress Prolactin Selenium deficiency
Micro adenoma
Cocaine Decidual prolactin

Lymphoblastoid prolactin Viral infection Toxemia

HTN

Auto immunity
Ventricular dysfunction
RISK FACTORS:

 Age of parity(either young/elderly gravida)

 Number of pregnancies
 Multiple pregnancy
 Pre eclampsia
 Gestational hypertension
 Oral tocolytic therapy ( beta adrenergic agonists)
SIGNS & SYMPTOMS:

 Dyspnea (shortness of breath )

 Orthopnea
 Unexplained cough
 Pitting odema in lower extremities
 Excessive weight gain during last month of pregnancy
 Palpitations
 Chest pain
DIAGNOSTIC CRITERIA:

 Development of heart failure during last month of pregnancy or within 5 months of

delivery
 Absence of an identifiable cause for the heart failure
 Absence of recognizable heart disease prior to the last month of pregnancy
 Left ventricular dysfunction determined during echocardiography with ejection
fraction <45 %
TREATMENT:

 Similar to congestive heart failure

 Diuretics
 Beta blockers
 Hydralazine with nitrates may replace ACE-I (breast feeding mothers or before
delivery)
 If EF<35% ,anticoagulation is indicated as risk of developing left ventricular thrombi
 In 50% women the clinical & echocardiographic status improves & return to
normal.
 Whereas the disease progresses to severe cardiac failure & even sudden cardiac
death.
 30-50% at risk for recurrence of left heart failure & death in sebsequent
pregnancies.
 Diagnosis is challenging since most women in last month of normal pregnancy or
soon after delivery experience dyspneae , fatigue & pedal oedema (as in our case).
 Hence the treating physician should have high index of suspicion & consider it when
managing dyspneic patients for this potentially lethal condition.
COVID 19 AND CARDIOMYOPATHY IN PREGNANCY
COVID 19 AND CARDIOMYOPATHY IN PREGNANCY
COVID 19 AND CARDIOMYOPATHY IN PREGNANCY
TERIMA KASIH