Figure 2: Chest X-ray of case 2 showing infiltrates in the
bilateral lower zone and blunting of bilateral costophrenic angles
Case 3
A 28 years lady,
G3P1L1A1at 37+1 weeks of gestation with impaired glucose tolerance, underwent
Emergency LSCS for oligohydramnios (AFI 4.3cm). On the
3rd postoperative day, she developed sudden onset
shortness of breath. On examination, she was tachypneic (40
breaths/minute) with low saturation of oxygen (SaO2-80%
in room air), raised blood pressure (140/100 mmHg), and had bilateral
pedal edema. On chest auscultation, bilateral wheezes, and basal
crepitations were heard, without any murmurs. ECG showed S1Q3T3 (right
heart strain) pattern. Serum NT-proBNP was 7269 pg/ml. Renal function
test (RFT)was deranged with urea 49 mg/dl, and creatinine 2.2 mg/dl with
normal Na+/K+. TTE showed: dilated left atrium and left ventricle,
global hypertrophy, left ventricular systolic dysfunction grade II with
an ejection fraction of 30%, and mild mitral regurgitation. She was
then managed under the diagnosis of PPCM with acute kidney injury: fluid
and salt restriction, input/output charting, daily RFT, BP charting,
propped-up position, diuretics, bromocriptine, and ACEIs. TTE repeated 9
days later showed mild hypokinesia of basolateral LV and LVEF of 40%.
She was discharged on ACEIs and bromocriptine which was continued for 2
months. She was followed up for 6 months where she was symptomatically
better and her RFTs were normal.