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Peripartum Cardiomyopathy (ICF (Participation (Mommy and Me classes, Avid…
Peripartum Cardiomyopathy
Medical Management
Diagnostic Testing (for systolic heart failure)
Blood Test: Elevated BNP and Pro-BNP
Echocardiogram: LVEF = 20%
CXR: Cardiomegaly
Auscultation Heart + Lungs: S3 heart sound (lub-dub-pa), crackles in lungs bases/pleural effusion
Treatment
Medications
Aldactone (Diuretic), Carvedilol (Beta Blocker), Capatopril (ACE Inhibitor), Lasix
Milrinone Infusion
of .25 mcg/kg/min 2 months ago- Used for short term treatment of HF, Relaxes blood vessels and has heart beat stronger to increase SV --> Can help symptoms of HF
Surgical
Short term
: LVAD - Motorized unit that helps push blood out of aorta and throughout the body (helps the left ventricle)
Risk factors: Clot formation, increased risk of R. ventricular dysfunction, increased risk of infection, bleeding complications
Long term
: Heart Transplant
Diagnostic Testing (for cardiomyopathy)
Diagnosis of exclusion
Echocardiogram:
often
shows LV dilatation of variable degrees, LV systolic dysfunction, right ventricular and biatrial enlargement, mitral and tricuspid regurgitation, and pulmonary hypertension
ICF
Environment
Lives in two story home with husband and child
Participation
Mommy and Me
classes
Avid
Netflix
viewer
Activities
Getting up stairs to her home
Personal Factors
34 y.o female, has 1 child and hot hubby
Body function / Structure
LVAD placement s/p 3 weeks ago due to peripartum cardiomyopathy
PT Intervention
(Based on
TYPE of LVAD,
the monitoring system may vary)
Upright Cycling
On upright cycle or UE/LE ergometer, at least 3 days/week, for 20-60 minutes, sustaining RPE between 12-16 and HR around 105 bpm
Walking/TM Training
Walking on TM at least 3 days/week, for 20-60 minutes, sustaining RPE between 12-16 and HR around 105 bpm
PT Education
LVAD precautions: Limited trunk rotation, avoid touching tv screen/computer monitors, Avoid bathing and submersion in water, wearing abdominal binder with activity
Resistance Training
Introduce strength training (hand weights + machine) for major muscle groups 2-3 days/week with rest days in between; 10-15 reps (x1-3 sets) without significant fatigue (RPE 11-13 or 40%-60% of 1-RM)
PT Evaluation
Hx, Auscultation, Pain Scale, RPE, Gross MMT, Gross Movement Assessment (transfers, bed mobility, ambulation), Cough Assessment. Note vitals such as BP and HR will not be reliable due to presence of LVAD
Pathophysiology
an idiopathic dysfunction that presents with a rapid onset of cardiac musculature weakness and an enlarged left ventricle
Impaired left ventricular ejection fraction --> resulting in decreased blood flow --> impaired oxygen and nutrients to vital organs
Systolic HF
: heart fails to function adequately specifically left ventricular contraction resulting in impaired ejection fracture
LVEF < 45% (normal is 60-65%)
Risk Factors: Age either > 30 years old or adolescent age, African American, hypertension, preeclampsia, multiple pregnancies, substance abuse, anemia, asthma, prolonged tocolytic use, DM, obesity, and malnutrition
Sx PPCM
: fatigue, dyspnea, feeling of heart racing or palpitations, increased nighttime urination, SOB with activity or lying flat (orthopnea), coughing, swelling of the ankles, swollen neck veins, low BP/OHTN
Class I - Disease with no symptoms
Class II - Mild symptoms/effect on function or symptoms only with extreme exertion
Class III - Symptoms with minimal exertion
Class IV - Symptoms at rest
