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Peripartum Cardiomyopathy (Possible risk factors (hypotension, Diabetes,…
Peripartum Cardiomyopathy
definition
uncommon form of heart failure that happens during the last month of pregnancy or up to five months after giving birth.
symptoms
fatigue
diminished exercise capacity
Shortness of breath
Persistent cough/wheezing
rapid or irregular heartbeat
Pathophysiology
Heart chambers enlarge
Myocardium weakens
Decreased LVEF
Systolic HF
Inadequate ejection of blood
Remaining blood in ventricles
Decrease amount of blood delivered to tissues
Hypoxia
Increased preload
Excessive blood in peripheral circulation
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Fluid build up in lungs
Crackles and coughing
Decreased aerobic capacity
Exertional dyspnea
Lower PA levels
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Left ventricular heart failure
Fluid may back up in your lungs
SOB
Cyanosis
right ventricular heart failure
fluid backs up into the peripheral circulatory system
edema
PT Evaluation
Pain scale
Breathing
Ambulation
Strength/ROM
Transfers/Functional Mobility
Vitals
follow LVAD monitoring guidelines
PMH/PSH
Endurance Testing
Incision
PT Treatment
Ambulation
Increased aerobic capacity
Pt ed
Sx and symptoms of exercise intolerance
Activity monitoring
Strengthening
Aerobic training
Energy conservation strategies
Chest PT/DBE
Scar mobilization
Possible risk factors
hypotension
Diabetes
Obesity
Genetic predisposition
Prior viral infection
Abnormal Immune response
Poor nutrition
CAD
Smoking
Alcoholism
African American Descent
Hx of cardiac problems
Multiparous
Twin gestation
Pre-eclampsia?
ICF
Personal factors
34 y.o. female
9 months post-partum
LVAD placement 3 weeks ago
Prescribed carvedilol, captopril, aldactone, lasix, and milrinone
Peripartum cardiomyopathy
Participation
Difficulty caring for child
Unable to work
Unable to exercise
Unable to grocery shop
Unable to participate in sport/recreation
Environmental factors
2-story home, 13 stairs
Lives with husband and infant child
Body structure and function
LVEF= 20%
Decreased endurance
SOB at rest
Decreased strength
Activities
Difficulty ambulating
Difficulty ascending/descending stairs
Symptoms of CHF at rest
Medical management
Diagnostic tests
Heart biopsy (r/o pericarditis)
Echocardiogram
R/o pre-eclampsia
LVAD placement
bridge to transplantation
surgically implanted mechanical pump that is attached to the heart
internal and external components.
actual pump sits on or next to your heart’s left ventricle with a tube attached that routes the blood to your aorta
apex of the left ventricle as the inflow site to the pump,
driveline extends from the pump, out through the skin, and connects the pump to a controller and power sources worn outside the body
Pharmacology
ACE inhibitors (Captopril)
Beta blockers (Carvedilol)
Diuretics (Aldactone, Lasix)
Digitalis
Anticoagulants
Monitoring
Low Na+ diet
Daily weighing
Fluid monitoring
Heart rate
Blood pressure
Diagnostic Criteria
Heart pumping function is reduced, with an ejection fraction (EF) less than 45%
No other cause for heart failure with reduced EF can be found
Heart failure develops in the last month of pregnancy or within 5 months of delivery
Leticia Antunes
Neil Toussaint Jessica Nguyen Aubrey Elstad Joseph Dubato