School of Medicine, Department of Family Medicine, Moi University, P. O. Box 3900-30100, Eldoret, Kenya.
BMC Psychiatry. 2020 Mar 11;20(1):114. doi: 10.1186/s12888-020-02522-2.
This case report highlights the rare occurrence of postpartum psychosis in the setting of peripartum cardiomyopathy, which can have rare presentations like arrhythmias and pulmonary edema; and the challenges one should anticipate while managing these conditions together. Caution is advised whenever antipsychotic drugs are to be administered to a patient with a cardiac condition as these drugs potentially increase the risk of arrhythmias and sudden death.
A 35 year old grand multiparous woman who was 1 week into puerperium was admitted with severe difficulty in breathing at rest, chest congestion and pain. She also had easy fatigability, orthopnea, paroxysmal nocturnal dyspnea, edema, tachycardia, tachypnea, irregularly irregular heart rate with a pulse deficit, elevated jugular venous pressure, cardiomegaly, hepatomegaly and pulmonary crepitations. On the sixth day while improving on standard drugs for heart failure, she developed bizarre behavior and confusion. She also had auditory, visual and olfactory hallucinations; violence to the baby and the husband; and refusal to feed and take medication. There was no altered sensorium and the vital signs were normal. She was diagnosed with puerperal psychosis during the management of peripartum cardiomyopathy.
In the rare occurrence of puerperal psychosis in the course of management of peripartum cardiomyopathy one must be acutely aware of the risk of sudden cardiac death occasioned by use of antipsychotics, either directly or due to arrhythmias. Continuous electrocardiogram (ECG) monitoring or use of alternative management modalities is thus highly advised.
本病例报告强调了围产期心肌病并发产后精神病的罕见情况，这种情况可能会出现心律失常和肺水肿等罕见表现；在同时管理这些病症时，应预料到各种挑战。在给患有心脏疾病的患者使用抗精神病药物时应谨慎，因为这些药物可能会增加心律失常和猝死的风险。
一名 35 岁的经产妇，产后 1 周，因严重呼吸困难、胸部充血和疼痛而入院。她还容易疲劳、端坐呼吸、阵发性夜间呼吸困难、水肿、心动过速、呼吸急促、心率不规则且有脉搏缺失、颈静脉压升高、心脏扩大、肝肿大和肺部啰音。第六天，在标准心力衰竭药物治疗有所改善的情况下，她出现了奇怪的行为和意识混乱。她还出现了听觉、视觉和嗅觉幻觉；对婴儿和丈夫的暴力行为；拒绝进食和服药。意识没有改变，生命体征正常。在围产期心肌病的管理过程中出现产后精神病，她被诊断为产后精神病。
在围产期心肌病管理过程中罕见发生的产后精神病中，必须高度警惕使用抗精神病药物引起的心律失常或直接引起的突发心脏死亡的风险。因此，强烈建议进行持续心电图（ECG）监测或使用替代管理方式。
