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|Number 09-15 Peripartum Cardiomyopathy?|
Number 09-15 Peripartum Cardiomyopathy?
Case From: D.H. Brown, B. J. Barber, N. Kalra, Y. Naughton, V. Sorrell; Institution - Department of Cardiology and Pediatric Cardiology, University of Arizona and Sarver Heart Center, Tucson, AZ, USA
Clinical history: A 36 year old female presented with irregular heart rate and palpitations following labor and delivery of her child.
Additional history: The patient was a known carrier of the Duchenne Muscular Dystrophy gene mutation with deletion of exons 49-52. CMR performed to distinguish peripartum cardiomyopathy from that of Duchenne Muscular Dystrophy induced cardiomyopathy.
CMR cine: Dilated LV cavity with multiple wall motion abnormalities and inferolateral dyskinesis.
CMR Delayed contrast enhancement: Extensive, mid-myocardial and sub-epicardial late gadolinium enhancement. This is consistent with muscular dystrophy or myocarditis, quantified as below.
Clinical Course: The patient was initially treated with carvedilol, lisinopril, and aldactone. There was little improvement in EF on 6 month follow-up. Frequent ectopy remained. This, in combination with the CMR findings of extensive scarring and fibrosis led to the recommendation for ICD implantation. Heart failure therapy will continue with an attempt to maximize ACE-I dosing as this has been reported to improve cardiac function in boys with muscular dystrophy.
COTW handling editor: James Moon