Cardiomyopathy is one of the leading causes of maternal mortality. Two subtypes include dilated cardiomyopathy and hypertrophic heart disease. Other cardiovascular diseases include Pulmonary hypertension, Aortic dissection, Unexplained sudden death, probable arrhythmia, Congenital heart disease, non-valvular, Coronary artery disease, and Valvular disease. Risk factors include obesity, African-American race/racism, hypertension during pregnancy, and illicit drug use (methamphetamine, cocaine). Symptoms include shortness of breath wheezing, palpitations, edema, chest pain, dizziness, or extreme fatigue. Signs may include hypertension (>140/90), tachycardia (>120), rales, +S3, and oxygen saturation <90%. Assessment includes diagnostic tools (EKG, BNP, echocardiogram, chest x-ray). Treatment includes consultation with cardiology and maternal-fetal medicine, stabilization, and targeting the underlying cause.
Questions to ask:
Monitor oxygen saturation, vital signs, and cardiac rhythm. Provide supplemental oxygen and assisted ventilation as needed. Place two intravenous catheters and position the patient upright. Provide non-invasive ventilation unless immediate intubation is required. Initiate loop diuretic therapy to relieve congestion/fluid overload (i.e., Furosemide). Hemodynamic support with inotropes and vasopressors if required. Follow recommended guidelines for either systolic or diastolic heart failure management. Additionally, arrhythmias can be present with peripartum cardiomyopathy, and consideration of an antiarrhythmic medication or implantable cardioverter-defibrillator (CD) and resynchronization therapy is necessary. Peripartum women are also at high risk from VTE and may warrant prophylaxis.