Figure 1: ECG of case 1 showing T wave inversion in leads V1-V4 and aVL.
Case 2
A 31 years lady, G2 P1L1 at 40 +6 weeks of gestation gave birth to a male baby via vaginal delivery with first-degree perineal tear following induction of labor for post-dated pregnancy. On the 4thday of puerperium, she was admitted for puerperal pyrexia with left pyelonephritis, moderate anemia, and hypokalemia. She was treated with antibiotics, potassium supplements, and two units of packed red blood cell (PRBC) transfusion. However, on the 6th day of puerperium, she developed shortness of breath, chest pain, dry cough, and orthopnoea. On examination, she had bilateral lower limb pitting edema with vitals within normal limits. In the chest radiograph, there were infiltrates in the bilateral lower zone and blunting of bilateral costophrenic angles (figure 2). Serum NT-proBNP was 1678pg/ml. TTE showed: dilated left atrium/left ventricle, mild tricuspid regurgitation, moderate pulmonary artery hypertension, left ventricle systolic dysfunction with an ejection fraction of 40%, and severe mitral regurgitation. She was then managed with the diagnosis of PPCM with left pyelonephritis. She was kept in a propped-up position, daily BP charting and renal function test was done and was managed with fluid restriction, diuretics, beta blocker, angiotensinogen converting enzyme inhibitors (ACEIs), bromocriptine, and antibiotics. She was symptomatically better and was discharged on the 14th day of puerperium with empagliflozin, torsemide, carvedilol, and cefixime with advice to follow up in cardiology and obstetrics and gynecology clinic.