Peripartum women with dyspnea in the emergency department

Wang, Weiwei; Wang, Yu

doi:10.1097/md.0000000000011516

Cited by 8 publications

(12 citation statements)

References 37 publications

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“…4 Physiological dyspnoea of pregnancy is thought to be induced by sex hormone-related hyperventilation and the increased metabolism in normal Peripartum cardiomyopathy in the Middle East pregnancy. 5 In addition, several other symptoms and clinical signs observed may also be seen in normal pregnancy. Weight gain and lower limb oedema, observed in most of our cases, may also be misinterpreted as consequences of changes in pregnancy.…”

Section: Discussionmentioning

confidence: 95%

“…Dyspnoea is commonly seen in normal pregnancy, affecting up to 60% of healthy women during exercise and 20% of women at rest 4 . Physiological dyspnoea of pregnancy is thought to be induced by sex hormone‐related hyperventilation and the increased metabolism in normal pregnancy 5 . In addition, several other symptoms and clinical signs observed may also be seen in normal pregnancy.…”

Section: Discussionmentioning

confidence: 99%

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Clinical presentation and outcomes of peripartum cardiomyopathy in the Middle East: a cohort from seven Arab countries

et al. 2020

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Aims Published data on the clinical presentation of peripartum cardiomyopathy (PPCM) are very limited particularly from the Middle East. The aim of this study was to examine the clinical presentation, management, and outcomes of patients with PPCM using data from a large multicentre heart failure (HF) registry from the Middle East. Methods and results From February to November 2012, a total of 5005 consecutive patients with HF were enrolled from 47 hospitals in 7 Middle East countries. From this cohort, patients with PPCM were identified and included in this study. Clinical features, in-hospital, and 12 months outcomes were examined. During the study period, 64 patients with PPCM were enrolled with a mean age of 32.5 ± 5.8 years. Family history was identified in 11 patients (17.2%) and hypertension in 7 patients (10.9%). The predominant presenting symptom was dyspnoea New York Heart Association class IV in 51.6%, class III in 31.3%, and class II in 17.2%. Basal lung crepitations and peripheral oedema were the predominant signs on clinical examination (98.2% and 84.4%, respectively). Most patients received evidence-based HF therapies. Inotropic support and mechanical ventilation were required in 16% and 5% of patients, respectively. There was one in-hospital death (1.6%), and after 1 year of follow-up, nine patients were rehospitalized with HF (15%), and one patient died (1.6%). Conclusions A high index of suspicion of PPCM is required to make the diagnosis especially in the presence of family history of HF or cardiomyopathy. Further studies are warranted on the genetic basis of PPCM.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Clinical presentation and outcomes of peripartum cardiomyopathy in the Middle East: a cohort from seven Arab countries

et al. 2020

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“…First, it should be considered that the onset of cardiomyopathy can easily be masked and missed. Pregnant women most commonly can present dyspnea, dizziness, atypical chest pain, cough, neck vein distension, fatigue, and peripheral edema [64]. PPCM is a diagnosis of exclusion; its definitive diagnosis depends on echocardiographic identification, although in PPCM the electrocardiogram may be normal.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Outcomes in Advanced Maternal Age Delivering Women. Clinical Review and Medico-Legal Issues

et al. 2019

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Background and objecives: Adverse cardiovascular outcomes during pregnancy have increased over the past few decades, with increased numbers of women delivering later in their reproductive life. Other factors include higher rates of female obesity, diabetes, hypertension, cardiovascular diseases and assisted reproductive technology, which has extended fertility. Those at risk require extensive prenatal maternal screening, constant pregnancy supervising, monitoring during labor, delivery and puerperium and careful anesthetic evaluation during delivery. Materials and Methods: The present review reports the relevant information available on cardiovascular outcomes in advanced maternal age delivering women and related medico-legal issues. The search was performed on Pubmed, Cochrane, Semantic Scholar, Medline and Embase databases, accessed by Ovid, including among others the terms “cardiomyopathy”, “ischaemic heart disease”, “arrhythmias”, “hypertension”, “peripartum period”, “diabetes”, “advanced maternal age” “anesthesia”, “maternal morbidity and mortality” and “litigation”. Results: To the extent that underestimating risk factors for peripartum cardiomyopathy (PPCM) can adversely impact maternal and fetal outcomes, the legal implications of misdiagnosis or mismanagement can result in high compensatory damages. Substantial indemnity payments drive up costs of insurance coverage. Conclusions: Multidisciplinary approaches are necessary from obstetricians, cardiologists, anesthesiologists and perinatologists for pregnancy monitoring and delivery outcomes.

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“…Preeclampsia is a cardiac condition that occurs during pregnancy and is caused by stress on the heart's ventricles. It is characterized by an increase in BNP levels [6][7][8]. The levels of BNP or NT-pro-BNP do not vary during normal pregnancy or the postpartum period, and they are only slightly raised in preeclampsia patients.…”

Section: Introductionmentioning

confidence: 99%

“…The levels of BNP or NT-pro-BNP do not vary during normal pregnancy or the postpartum period, and they are only slightly raised in preeclampsia patients. On the other hand, an earlier BNP test could benefit the diagnosis of PPCM [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Utility of NT-proBNP in the Diagnosis and Prognosis of Pregnancy Associated Cardiovascular Conditions: A Systematic Review

Esbrand¹,

Zafar²,

Panthangi³

et al. 2022

Cureus

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Cardiovascular disease includes many diseases such as heart failure, cardiomyopathy, valvular disease, pericardial disease, peripheral vascular disease, rheumatic heart disease, and vascular disease to name a few. Cardiovascular disease in pregnancy is on the rise especially with women being pregnant at an older age. Brain natriuretic peptide (BNP), could be a factor in determining the severity. BNP is elevated in heart failure. This study will attempt to determine the relationship between BNP and pregnancy outcomes in women with heart failure. A Keyword combination search was performed using varying databases. Inclusion and exclusion criteria were implemented and relevant articles were obtained to formulate ideas to support the topic. BNP, the amino acid peptide is secreted by both atrial and ventricular monocytes. BNP and Nterminal (NT)-pro hormone BNP (NT-proBNP) are elevated in heart failure and seen in pregnant women alike. Within 6-12 weeks it returns to normal levels. Normal levels were shown to have good pregnancy outcomes in that the baby is healthy with normal birth weight and the mother is free of cardiovascular complications, whereas at elevated levels the pregnancy outcome was not favorable. NT-proBNP, when elevated in the pregnant patient, is a predictor of poor pregnancy outcomes, especially in patients with precursors. Testing for this peptide in pregnant women during the early stages of pregnancy could help determine the best course of action for a better outcome.

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Peripartum women with dyspnea in the emergency department

Cited by 8 publications

References 37 publications

Clinical presentation and outcomes of peripartum cardiomyopathy in the Middle East: a cohort from seven Arab countries

Clinical presentation and outcomes of peripartum cardiomyopathy in the Middle East: a cohort from seven Arab countries

Cardiovascular Outcomes in Advanced Maternal Age Delivering Women. Clinical Review and Medico-Legal Issues

Utility of NT-proBNP in the Diagnosis and Prognosis of Pregnancy Associated Cardiovascular Conditions: A Systematic Review

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