Peripartum Kardiyomiyopati Tanılı Hastada Yoğun Bakım Yönetimi
Özet
Peripartum kardiyomiyopati (PPKM), daha önce bilinen kalp hastalığı olmayan kadınlarda gebeliğin son döneminde veya doğum sonrası ilk aylarda ortaya çıkan, sol ventrikül sistolik disfonksiyonu ile karakterize nadir ancak ciddi bir kalp yetmezliği tablosudur. Erken tanı ve uygun tedavi sağlanamadığında maternal morbidite ve mortalite riski yüksektir. Bu olguda, doğumdan iki hafta sonra nefes darlığı şikayeti ile başvuran 37 yaşındaki multipar bir hastanın yoğun bakım yönetimi sunulmuştur. Hastanın değerlendirilmesinde hipotansiyon, taşikardi, metabolik asidoz, multiorgan yetmezlik bulguları ve ekokardiyografide %25 ejeksiyon fraksiyonu saptanmış olup kardiyojenik şok ile komplike PPKM tanısı düşünülmüştür. Yoğun bakım ünitesinde hastaya yüksek akım oksijen tedavisi, noradrenalin ile vazopressör destek, levosimendan ile inotrop tedavi, esmolol infüzyonu ile hız kontrolü, geniş spektrum antibiyotik tedavisi ve oligüri ile ciddi metabolik asidoz nedeniyle sürekli veno-venöz hemodiyafiltrasyon uygulanmıştır. İzlem sürecinde hastanın klinik ve hemodinamik parametrelerinde belirgin düzelme sağlanmış, beşinci günde organ destek tedavileri sonlandırılmıştır. Altıncı günde kardiyoloji servisine devredilen hasta ileri izlem sonrası şifa ile taburcu edilmiştir. Bu olgu, kardiyojenik şok ve multiorgan yetmezlik ile seyreden PPKM hastalarında erken tanı, multidisipliner yaklaşım ve zamanında başlanan ileri yoğun bakım tedavisinin prognozu belirgin şekilde iyileştirebileceğini göstermektedir.
Peripartum cardiomyopathy (PPCM) is a rare but serious heart failure condition characterized by left ventricular systolic dysfunction that occurs in women without previously known heart disease during the late period of pregnancy or within the first months after delivery. The risk of maternal morbidity and mortality is high when early diagnosis and appropriate treatment cannot be achieved. In this case, the intensive care management of a 37-year-old multiparous patient who presented with the complaint of dyspnea two weeks after delivery is presented. In the evaluation of the patient, hypotension, tachycardia, metabolic acidosis, findings of multiorgan failure, and an ejection fraction of 25% on echocardiography were detected, and PPCM complicated with cardiogenic shock was considered. In the intensive care unit, high-flow oxygen therapy, vasopressor support with norepinephrine, inotropic therapy with levosimendan, rate control with esmolol infusion, broad-spectrum antibiotic therapy, and continuous veno-venous hemodiafiltration due to oliguria and severe metabolic acidosis were administered. During the follow-up period, a significant improvement was achieved in the clinical and hemodynamic parameters of the patient, and organ support therapies were discontinued on the fifth day. The patient, who was transferred to the cardiology ward on the sixth day, was discharged with recovery after further follow-up. This case demonstrates that early diagnosis, a multidisciplinary approach, and timely initiated advanced intensive care treatment can significantly improve prognosis in PPCM patients presenting with cardiogenic shock and multiorgan failure.
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