peripartum cardiomyopathy

1. Case Presentation on PPCM

2. Demographic Details of Patient
• Name: Mrs Rajeshwari
• Age: 29 yrs
• Gender: Female
• Occupation: House wife
• DOA: 14/5/2022
• IP no: 558006

3. Chief Complaints
• Sudden onset Severe SOB Grade III – IV since morning
• Decreased Urine Output
• Weakness
• Poor Appetite
• H/o Fever, dry cough

4. Past History
• Medical History : Gestational DmT2, Pre eclampsia
• Medication History : was on medication
• Family History: No FHO cad
• Social History: Nil
• Allergies: NKA
• Surgeries: LSCS with twin (4/5/2022)

5. Physical Examination
• General Examination : P- I- C- C- K- L- E(B/L pitting edema)
• BP:130/80 mmHg
• Pulse rate: 84 bpm
• RR: 30/min
• RS: B/L severe crepts
• CVS: s1 s2
• CNS: No FND
• P/A: Soft, non tender C section scar

6. Provisional Diagnosis
• Viral Cardiomyopathy
• Cardiomyopathy
• PPCM

7. SOAP Analysis
Subjective Evidence:
• Sudden onset of SOB,
• decreased urine output

8. Objective Evidence
ECG:

9. 2d echo

10. Laboratory values
• Hb: 11.20
• TLC: 13270
• Pc: 5.50
• Serum Creatinine: 0.60
• Potassium: 4.30

11. Assessment
• Based on Subjective and objective evidence patient diagnosed as
Postpartum Cardiomyopathy

12. Goals Of therapy
Patient specific goals:
• To Provide symptomatic relief
Disease specific goals:
• To decongest
• To improve heart function
• To improve morbidity and mortality

13. Sl.n
o
Name of drug Dose ROA Freq Day1 Day2 Day3 Day4 Day5
1. Inj Lasix ( furosemide) 40+40 mg IV STAT . . . . .
2. Dytor Infusion 1mg/hr IV
3. Dobutamine Infusion 5mcg/kg/min IV . .
4. INJ Heparin 5000 IV QID . . .
5. Tab. Ivabrad 5mg RT BD . .
6. Tab Bromocriptin 5mg RT BD . . . 2.5 2.5
7. Tab Magnex Forte 1.5mg IV BD . . . . .
8. Tab Isolazine RT BD
9. Inj Celecil 1 amp IV OD
10. Tab Q180 1tab RT OD
11. Tab. Cidmus 50mg RT BD

14. Sl.no Name of Drug Dose ROA Freq
13. Tab cordarone 200 PO BD
12. Tab Cardivas 3.125mg RT BD
14. Tab Ixarola 15 PO OD
15. Tab optineuron 1tab PO OD
16. Tab Aldactone 25mg PO OD
11. Tab. Digoxin (1/2 tab) 0.25
mg
RT OD
12. Syp Potklor 15ml RT TID
11. Tab. Digoxin (1/2 tab) 0.25
mg
RT OD

15. Drug Interactions

16. Therapeutic Monitoring Parameters
1. Dobutamine: Monitor BP, HR, ECG, UO
2. Digoxin: Monitor serum digoxin levels
3. Heparin: Monitor APTT
4. Bromocriptine: Monitor renal, hepatic, cardiovascular
5. Inj Magnex forte: Monitor Serum levels, WBCs
6. Tab Ivabrad: Monitor Heart Rate, Rhythm
7. Tab Cordarone:
8. Tab Cidmus
9. Tab Carvidelol
10. Tab Lasix

17. Day 3
Pt developed VT Torsade point (unstable, pulseless, up rolling of eyes)
Treated with
• Inj Cordarone 300mg IV bolous
• Inj Mgso4 2gm IV Stat
• KCL Infusion
• Electrolytes, Mg, Ca checked

18. Pt Improvement

19. Discharge Medication

20. Toxicity parameters

21. Patient counselling
1. Disease
2. Drug
3. Diet
4. Lifestyle Modification

22. THANK YOU