Periapartalna kardiomiopatija

M. Šipić ,
M. Šipić
S. Lazić ,
S. Lazić
M. Fajertag ,
M. Fajertag
D. Rašić ,
D. Rašić
G. Antić
G. Antić

Published: 15.01.2014.

Volume 42, Issue 3 (2013)

pp. 73-77;

Abstract

Peripartalna kardiomiopatija (PPKM) je redak poremećaj srčane slabosti nepoznatog uzroka koji je često fatalan za mlade žene. Javlja u kasnoj trudnoći ili postpartalnom periodu. PPKM može biti teško dijagnostikovati jer simptomi srčane slabosti mogu imitirati one simptome koji se inače javljaju u trudnoći. Prikaz bolesnika,29- godišnja žena, u 38 nedelji gestacije primljena je na odeljenje zbog otežanog disanja, zamora pri minimalnom naporu i osećaja ubrzanog lupanja srca. Na prijemu bleda, lako oznojena i dispnoična, blede kože i vidljivih sluznica. Gojazna. Auskultacijom na plućima bazalno obostrano oslabljen disajni šum uz inspirijumske pukote bazalno desno. Akcija srca je tahikardna (135 /min) , tonovi oslabljeni, ritam galopa, sistolni šum na ictusu 3/6 po Levinu. TA 130/90. Abdomen je iznad ravni g. koša, inspekcijom se uočavaju gravidarne strije. Ekstremiteti bez edema. Elektrokardiogram pokazuje sinusnu tahikardiju sa fr 130/min, pQ 0,10 sec,qr u D3, slaba progresija r zubca od V1-V4, bifazan p talas u V1, povremene VES, nema značajnih ST-T promena. Odmah urađena transtorakalna ehokardiografija (TTE) pokazala je levi ventrikul uvećanih enddijastolnih i endsistolnih dimenzija (EDDLV 82mm, ESDLV 72 mm), uredne debljine zidova, sa globalnom hikpokinezijom i bez regionalnih ispada u kinetici, sa sniženom EF koja je procenjena na oko 25-30%. Tretirana kardiotonicima, diureticima, uz suspstituciju kalijuma, i Antagonistima kalcijuma što dovodi do poboljšanja stanja. Nakon 5 dana trudnoća je završena carskim rezom i rođeno je zdravo žensko dete. Zaključak: Peripartalna kardiomiopatija je oboljenje čija je etologija još uvek nedovoljno rasvetljena, i na na našim prostorima nije tako česta, ali neblagovremena ili zakasnela dijagnoza su fatalni za trudnicu.

Keywords

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