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Abstract
RÉSUMÉ
La cardiomyopathie péripartum est reconnue comme une cause majeure d'insuffisance cardiaque liée à la grossesse avec une morbidité et une mortalité élevée. Des complications thrombo-emboliques en sont révélatrices. Nous rapportons une forme clinique de cardiomyopathie du peripartum chez une patiente de 26 ans hospitalisée, invalidante d’un syndrome coronaire aigu et d’un accident vasculaire cérébral après 10 jours de son 2ème geste. L’ECG était en faveur d’anomalies de la repolarisation suggestives d’ischémie grade I à II en quasi-circonférenciel et les Troponines étaient élevées à 26 fois la normale. L’échographie cardiaque a confirmé l’altération de la fonction ventriculaire globale à 34% sans autres atteintes associées. Fait important est la mise en évidence de thrombi intra- auriculaire gauche. La Tomographie cérébral a confirmé l’infarctus sylvien gauche. Les formes compliquées de cardiomyopathie du périartum (embolie artérielle) sont graves et peuvent revêtir un syndrome coronaire aigu et /ou un accident vasculaire cérébral comme ce fut notre observation.
ABSTRACT
Peripartum cardiomyopathy is recognized as a major cause of pregnancy-related heart failure with high morbidity and mortality. Thromboembolic complications are revealing. We report a clinical form of peripartum cardiomyopathy in a 26-year-old hospitalized patient with acute coronary syndrome and a stroke after 10 days of her second procedure. The ECG was in favor of repolarization abnormalities suggestive of grade I to II ischemia near circumferential and Troponins were elevated to 26 times normal. Cardiac ultrasound confirmed the 34% deterioration in overall ventricular function with no other associated damage. Important fact is the demonstration of left intra auricular thrombi. Brain tomography confirmed the left sylvic infarction. Complicated forms of peripartum cardiomyopathy (arterial embolism) are severe and may take on acute coronary syndrome and / or stroke as was our observation.
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References
- RÉFÉRENCES
- - Hilfiker-Kleiner D, Haghikia A, Nonhoff J, Bauersachs J. Peripartum cardiomyopathy: current management and future perspectives. Eur Heart J .2015;36:1090–1097
- - Cardiomyopathie du péripartum compliquée d’accident vasculaire cérébralcas d’une guinéenne de 19ans : cas clinique. American journal of Cardiology and Cardiovascular diseases. 2019; (1): 01-03
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- - Elkayam U. Clinical characteristics of peripartum cardiomyopathy in the United States : diagnosis, prognosis, and management. J Am Coll Cardiol. 2011 ;58:659–670. doi: 10.1016/j.jacc.2011.03.047.
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- - Sangaré, I., Bâ, H., Camara, Y., Sonfo, B., Thiam, C., Sidibé, N., Traoré, A., Camara, H., Diarra, B., Coulibaly, S., Menta, I., Diall, I., & Diarra, M. B. (2021). Complications Thromboemboliques des Insuffisances Cardiaques en Hospitalisation dans le Service de Cardiologie du CHU Gabriel Touré (Bamako). Health Sci. Dis: Vol 22(5) May 2021 pp75-79
- - Greer IA. Clinical practice : pregnancy complicated by venous thrombosis. N Engl J Med. 2015 ;373 :540–547. doi: 0.1056/NEJMcp1407434
- - Arany Z, Elkayam U. Peripartum Cardiomyopathy. Circulation. 2016 Apr 5;133(14):1397-409. doi: 10.1161
- - Kolte D, Khera S, Aronow WS, Palaniswamy C, Mujib M, Ahn C, Jain D, Gass A, Ahmed A, Panza JA, Fonarow GC. Temporal trends in incidence and outcomes of peripartum cardiomyopathy in the United States : a nationwide population-based study. J Am Heart Assoc. 2014 ;3:e001056 doi: 10.1161/JAHA.114.001056
- - Shimamoto T, Marui A, Oda M, Tomita S, Nakajima H, Takeuchi T, Komeda M. A case of peripartum cardiomyopathy with recurrent left ventricular apical thrombus. Circ J. 2008;72:853–854
- - Kharwar RB, Chandra S, Dwivedi SK, Saran RK. A pedunculated left ventricular thrombus in a women with peripartum cardiomyopathy: evaluation by three dimensional echocardiography. J Cardiovasc Ultrasound. 2014;22:139–143. doi: 10.4250/jcu.2014.22.3.139
References
RÉFÉRENCES
- Hilfiker-Kleiner D, Haghikia A, Nonhoff J, Bauersachs J. Peripartum cardiomyopathy: current management and future perspectives. Eur Heart J .2015;36:1090–1097
- Cardiomyopathie du péripartum compliquée d’accident vasculaire cérébralcas d’une guinéenne de 19ans : cas clinique. American journal of Cardiology and Cardiovascular diseases. 2019; (1): 01-03
- Cooper LT, Marther PJ, Alexis JD, et al. Myocardial recovery in peripartum cardio- myopathy: propestive comparison with recent onset cardiomyopathy in men and non peripartum women. Journal of cardiac failure. 2012;18:28–33
- Langheri AH, Khan AH, Kasmi KH. Peripartum cardiomyopathy: ten year experience at a tertiary care hospital in Pakistan. BMC Res Notes. 2013;36:495.
- Zehir R, Karabay CY, Kocabay G, Kalayci A, Akgun T, Kirma C. An unusual presentation of peripartum cardiomyopathy: recurrent transient ischemic attacks. Rev Port Cardiol. 2014;33:561.e1–561.e3. doi: 10.1016/j.repc.2014.02.
- Goland S, Modi K, Bitar F, Janmohamed M, Mirocha JM, Czer LS, Illum S, Hatamizadeh P, Elkayam U. Clinical profile and predictors of complications in peripartum cardiomyopathy. Journal of cardiac failure. 2009;8:645– 650
- Silwa K, Mebazaa A, Hilfiker-Kleiner D, et al. Clinical characteristics of patients of worldwide registry on peripartum cardiomyo- pathy (PPCM): EURObservational research program in conjunction with the heart failure association of the European Society of Cardi-ology Study Group on PPCM. Eur J Heart Fail. 2017;19:1131–41.
- Elkayam U. Clinical characteristics of peripartum cardiomyopathy in the United States : diagnosis, prognosis, and management. J Am Coll Cardiol. 2011 ;58:659–670. doi: 10.1016/j.jacc.2011.03.047.
- Kane A, Mbaye M, Ndiaye MB, Diao M, Moreira PM, Mboup C, Diop IB, Sarr M, Kane A, Moreau JC, Ba SA. Evolution and hromboembolic complications of the idiopathic peripartal cardiomyopathy at Dakar University Hospital: forward-looking study about 33 cases [in French]. J Gynecol Obstet Biol Reprod (Paris). 2010;39:484–489. doi: 10.1016/j.jgyn.2010.01.008
- Sangaré, I., Bâ, H., Camara, Y., Sonfo, B., Thiam, C., Sidibé, N., Traoré, A., Camara, H., Diarra, B., Coulibaly, S., Menta, I., Diall, I., & Diarra, M. B. (2021). Complications Thromboemboliques des Insuffisances Cardiaques en Hospitalisation dans le Service de Cardiologie du CHU Gabriel Touré (Bamako). Health Sci. Dis: Vol 22(5) May 2021 pp75-79
- Greer IA. Clinical practice : pregnancy complicated by venous thrombosis. N Engl J Med. 2015 ;373 :540–547. doi: 0.1056/NEJMcp1407434
- Arany Z, Elkayam U. Peripartum Cardiomyopathy. Circulation. 2016 Apr 5;133(14):1397-409. doi: 10.1161
- Kolte D, Khera S, Aronow WS, Palaniswamy C, Mujib M, Ahn C, Jain D, Gass A, Ahmed A, Panza JA, Fonarow GC. Temporal trends in incidence and outcomes of peripartum cardiomyopathy in the United States : a nationwide population-based study. J Am Heart Assoc. 2014 ;3:e001056 doi: 10.1161/JAHA.114.001056
- Shimamoto T, Marui A, Oda M, Tomita S, Nakajima H, Takeuchi T, Komeda M. A case of peripartum cardiomyopathy with recurrent left ventricular apical thrombus. Circ J. 2008;72:853–854
- Kharwar RB, Chandra S, Dwivedi SK, Saran RK. A pedunculated left ventricular thrombus in a women with peripartum cardiomyopathy: evaluation by three dimensional echocardiography. J Cardiovasc Ultrasound. 2014;22:139–143. doi: 10.4250/jcu.2014.22.3.139