Peripartum Kardiyomiyopatide Klinik Karar Süreci: Olgu Temelli Yaklaşım
Özet
Peripartum kardiyomiyopati, gebeliğin son döneminde veya doğum sonrası aylarda ortaya çıkan, etiyolojisi açıklanamayan sol ventrikül sistolik disfonksiyonu ile karakterize, nadir ancak potansiyel olarak yaşamı tehdit eden bir kardiyomiyopatidir ve fizyolojik postpartum semptomlarla örtüşmesi nedeniyle tanı sıklıkla gecikmektedir. Bu olgu sunumunda, doğumdan üç ay sonra dispne, ortopne ve periferik ödem yakınmaları ile başvuran 22 yaşındaki bir kadın hastada peripartum kardiyomiyopati tanı ve yönetimi sunulmaktadır. Transtorasik ekokardiyografide ileri derecede sol ventrikül sistolik disfonksiyonu ve apikal intrakaviter trombüs saptanmış, klinik ve diğer tanısal değerlendirmelerle sekonder nedenler dışlanmıştır. Hastaya intravenöz diüretik tedavi ile birlikte kılavuz temelli kalp yetersizliği tedavisi başlanmış ve trombüs varlığı nedeniyle antikoagülan tedavi uygulanmıştır. Tedavi sürecinde semptomlarda belirgin gerileme sağlanarak hasta klinik olarak stabil durumda taburcu edilmiştir. Bu olgu, postpartum dönemde gelişen kalp yetersizliği semptomlarının dikkatle değerlendirilmesi ve erken kardiyak görüntülemenin tanı ve tedavi açısından kritik önemini vurgulamaktadır.
Peripartum cardiomyopathy is a rare but potentially life-threatening cardiomyopathy characterized by unexplained left ventricular systolic dysfunction occurring in the last months of pregnancy or during the postpartum period. Because its clinical manifestations may overlap with physiological postpartum symptoms, diagnosis is frequently delayed. In this case report, we present the diagnostic and therapeutic management of a 22-year-old woman admitted with dyspnea, orthopnea, and peripheral edema three months after delivery. Transthoracic echocardiography demonstrated severe left ventricular systolic dysfunction accompanied by an apical intracavitary thrombus, while secondary causes of cardiomyopathy were excluded through clinical and diagnostic evaluation. The patient was treated with intravenous diuretic therapy and guideline-directed heart failure treatment, and anticoagulant therapy was initiated because of the presence of left ventricular thrombus. Significant symptomatic improvement was achieved during hospitalization, and the patient was discharged in clinically stable condition. This case highlights the importance of careful evaluation of postpartum heart failure symptoms and emphasizes the critical role of early cardiac imaging in the diagnosis and management of peripartum cardiomyopathy.
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