Amit Ben Hayman, Marmor Alon, Hussein Amer
Emergency Department, Tel Aviv Medical Center, Tel Aviv, Israel.
BMJ Case Rep. 2010 Dec 20;2010:bcr0520103039. doi: 10.1136/bcr.05.2010.3039.
A 34-year-old woman presented to the emergency department with severe dyspnoea 10 days following a normal-course caesarean delivery. She had been experiencing shortness of breath throughout the third trimester of pregnancy accompanied by tachycardia (110 bpm); however, her evaluation did not include ECG or chest radiography to elucidate the cause. Following delivery, chest radiography was performed demonstrating predominantly unilateral findings interpreted as pneumonia. ECG revealed T-wave inversion in leads V(4)-V(6), which was unaddressed. Overnight she deteriorated and a chest CT angiography was performed demonstrating heart enlargement and pulmonary oedema. An echocardiogram established a diminished ejection fraction (EF) of 15-20%, suggesting the diagnosis of peripartum cardiomyopathy. She was treated with angiotensin-converting enzyme inhibitors, spirinolactone and furosemide, and was free of symptoms the following month with an EF of 40-45%. Though uncommon, heart failure is a potentially fatal cause of peripartum dyspnoea, often misdiagnosed, meriting further attention.
一名34岁女性在剖宫产术后10天因严重呼吸困难就诊于急诊科。她在妊娠晚期一直感到呼吸急促，并伴有心动过速（110次/分钟）；然而，她的评估未包括心电图或胸部X线检查以明确病因。分娩后，进行了胸部X线检查，结果显示主要为单侧病变，诊断为肺炎。心电图显示V(4)-V(6)导联T波倒置，但未作处理。夜间她病情恶化，进行了胸部CT血管造影，显示心脏增大和肺水肿。超声心动图显示射血分数（EF）降低至15%-20%，提示围产期心肌病的诊断。她接受了血管紧张素转换酶抑制剂、螺内酯和呋塞米治疗，次月症状消失，EF为40%-45%。心力衰竭虽然不常见，但却是围产期呼吸困难的潜在致命原因，常被误诊，值得进一步关注。
