Bromocriptine use for sudden peripartum cardiomyopathy in a patient with preeclampsia: a case report

Abstract

Background: Peripartum cardiomyopathy is an uncommon form of heart failure that occurs in otherwise healthy women during pregnancy or until 5 months postpartum. Here, we report a rare case where a female patient underwent cesarean section after the occurrence of preeclampsia and intrauterine fetal death, and developed peripartum cardiomyopathy following postsurgical respiratory distress. The prompt initiation of inotropic drug and bromocriptine therapy quickly restored cardiac function. Case presentation: The patient was a 36-year-old woman who underwent emergency cesarean section for a previous preeclampsia and an intrauterine fetal death that occurred after 24 weeks of pregnancy. In addition, the patient had an extremely low platelet count of 5000/μL on admission. She had been diagnosed as idiopathic thrombocytopenic purpura at the age of 29 years old and treated with prednisolone at 15 mg/day. Therefore, the cesarean section was performed under general anesthesia. The patient did not exhibit respiratory or hemodynamic dysfunction during surgery. However, she developed respiratory distress with sinus tachycardia after extubation and was transferred to the intensive care unit. A chest radiograph showed butterfly shadows, and transthoracic echocardiogram confirmed the reduction of left ventricle contractility (ejection fraction 20%). She was diagnosed with peripartum cardiomyopathy and treated immediately with intravenous milrinone, oral bromocriptine, and angiotensin-converting enzyme inhibitor. Respiratory and hemodynamic function improved rapidly, and the patient was moved to the general ward 2 days after surgery. Fourteen days after surgery, the patient had an ejection fraction of 57%. The patient recovered without any further complications and was discharged 24 days after surgery. Conclusion: A sudden case of peripartum cardiomyopathy was successfully managed by a prompt diagnosis and treatment with inotropic agents and bromocriptine.

Unveiling the Mystery of Peripartum Cardiomyopathy: A Traditional Review

“…It was speculated that prolactin over-secretion increased the amount of a 16-kDa antiangiogenic prolactin fragment, which, as mentioned above, has played a vital role as a pathological mediator of PPCM by adversely affecting myocardial micro-vascularization [8,27]. As a result, initiating bromocriptine therapy, an anti-prolactin, may decrease the level of the 16-kDa fragment and help improve the general cardiac function [27,29].…”

“…Nonetheless, it is best to wait for the normalization of left ventricular (LV) function before stopping medications, and women should also be informed that they are still at a high risk of recurrence even if their LV function has returned to the normal state. However, PPCM could still lead to a severe and sometimes persistent decrease in LV function or even life-threatening complications, as the long-term outcomes have not yet been established with clarity [29,31].…”