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.