Christie Anne I. Pabelico
Cardiology at Perpetual Help Medical Center Las Pinas, Philippines
Title: Not Always Just Two Sides to Every Story: Stroke in Peripartum Cardiomyopathy and Hyperthyroidism
Biography
Biography: Christie Anne I. Pabelico
Abstract
Peripartum cardiomyopathy, in itself, is a rare condition. Often undiagnosed early, most cases are those already with complications, usually in decompensated heart failure. The symptoms are not recognized promptly because of the close resemblance to the normal spectrum of pregnancy. In rare occasions, this form of cardiomyopathy can be the etiology of stroke.
A 33 year old female G5P4, known hyperthyroid, admitted in labor and delivered to a live baby boy, with no complications. On the 12th hour postpartum, noted sudden onset of right-sided body weakness. Imaging showed infarct of varying ages on the left frontal lobe. Suspecting a probable embolic origin, electrocardiogram revealed sinus tachycardia but 2D echocardiogram showed global hypokinesia with ejection fraction of 30%. During ICU stay, the patient had difficulty breathing with concomitant desaturations, associated with tachycardia. With a background of hyperthyroidism, thyroid storm was also entertained, thus, the debate regarding the etiology of heart failure secondary to thyrotoxic heart disease versus peripartum cardiomyopathy was raised.
Currently, there are no related literature regarding the incidence of all entities occurring in the same setting.
The case presented a gray area in stroke in the spectrum of pregnancy, peripartum cardiomyopathy and hyperthyroidism because the incidence of these in the same setting is rare. It is unfortunate that the patient already suffered the devastating consequence leading to morbidity on diagnosis. The importance of a high index of suspicion and prompt diagnosis are keys, as well as adherence to medications and patient education, to guide proper management and prevent complications.