Jacobs Journal of Experimental Cardiology and research

Main considerations in the diagnosis of puerperal myocarditis: A case report

*Idiberto José Zotarelli Filho
Department Of Cardiology, Domingo Braile Institute Of Sao Jose Do Rio Preto , Vila Redentora, Sao Jose Do Rio Preto, Brazil

*Corresponding Author:
Idiberto José Zotarelli Filho
Department Of Cardiology, Domingo Braile Institute Of Sao Jose Do Rio Preto , Vila Redentora, Sao Jose Do Rio Preto, Brazil
Email:m.zotarelli@gmail.com

Published on: 2019-12-16

Abstract

Introduction: Myocarditis (MC) can result from a variety of infectious and non-infectious causes, and the secondary MC due to viral infection is the most prevalent form. Acute and nonfatal MC, on the other hand, has a more indolent presentation with mortality up to 20.0% in the first year and 55.0% over 11 years based on the initial diagnosis of acute MC. The diagnostic evaluation of MC is initially done through clinical suspicion, together with non-invasive diagnostic methods. In this sense, we highlight the Echocardiography with Strain. Objective: To present a case report and literature review on puerperal myocarditis, discussing the main forms of diagnosis. Case report: The CBB patient, 25 years old, female, with no known illness, after childbirth, reports that two weeks ago the patient had started upper airway infection with partial improvement after specific antimicrobial treatment. She complained of chest discomfort and dyspnea on exertion with few hours of evolution, when he sought medical care in the emergency room, where he was submitted to complementary analysis by biochemical markers, echocardiogram, and cardiac magnetic resonance. Therefore, she was diagnosed with puerperal myocarditis. Final considerations: The present study presented and discussed through literature a case of puerperal myocarditis in a young patient, whose diagnosis was due to imaging, blood count and C-reactive protein. The therapeutic proposal was similar to the other types of HF with systolic ventricular dysfunction. However, modifications to standard therapy were necessary to ensure the safety of the mother and breastfeeding.

Keywords

Puerperal myocarditis; Cardiac magnetic resonance; Echocardiogram; Diagnosis

Introduction

Pregnancy is associated with marked physiological changes that challenge the cardiovascular system. Among the most serious cardiovascular complications associated with pregnancy, peripartum cardiomyopathy (PCM) is a potentially fatal heart disease that arises in late pregnancy or the first months postpartum in previously healthy women [1]. A major challenge is to distinguish peripartum discomfort in healthy women (fatigue, shortness of breath, and edema) from the pathological symptoms of PCM. In addition, pregnancy-related conditions such as preeclampsia, myocarditis, or underlying genetic disease show overlapping symptoms with PCM [2]. Difficulties in diagnosing and discriminating from other pathological conditions in pregnancy may explain why PCM is still underestimated. In addition, the underlying pathophysiology is poorly understood, biomarkers are scarce and treatment options are generally limited. Experience in long-term prognosis and management, including subsequent pregnancies, is just beginning to emerge [3]. In this sense, some work has observed new aspects of physiological and pathophysiological changes of the maternal cardiovascular system comparing normal conditions, hypertensive complications, genetic aspects and infectious diseases in pregnancies with PCM. It also presents basic clinical and scientific data on the current state of knowledge about PCM and puts it in context, thus highlighting promising new perspectives on diagnostic tools and therapeutic and management approaches [4]. Therefore, this paper aimed to present a case report and literature review on puerperal myocarditis, discussing the main forms of diagnosis.