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.