Quick Fire Cases
Maribel Jimenez Toxqui, MD
CT and CMR Consultant
CT scanner, Mexico
Maribel Jimenez Toxqui, MD
CT and CMR Consultant
CT scanner, Mexico
Sandra G. Rosales Uvera, MD
Chief Cardiac Magnetic Resonance and Coronary Angiotomography
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
Jorge Paz Moreno, MD
Fellow in trainning
CT scanner, Mexico
Silvia Siu Moguel, MD, MSc
Medico
unidad medica Juan Pablo II, Mexico
45-year-old woman, diabetes and hypertension denied, smoking denied. Gynecological-obstetric history, eutocic delivery, late postpartum.
April 2023: Immediate postpartum period she presents de novo BCRIHH, at that time asymptomatic cardiovascular. Echocardiogram performed LVEF 54%, without alterations in contractility.
june 2023: She subsequently develops dyspnea, orthopnea, edema in the lower limbs. Echocardiogram reports eccentric hypertrophy, basal and middle inferoseptal akinesia, rest of the segments with severe hypokinesia. LVEF 19%, strain -10%. Decreased right ventricular function. Moderate mitral insufficiency, moderate tricuspid insufficiency. Coronary artery angiotomography, right dominance, epicardial arteries without lesions. Cardiac MRI reports dilated cardiomyopathy, LVEF 14%, RVEF 24%, tissue characterization sequences: STIR are negative (1.4), and hyperemia is positive (4.5). Late gadolinium enhancement in the apical septal epicardial region, late linear enhancement in the mid-segment septal mesocardial region, 2.3 g, representing 3.3% of myocardial mass. Based on MRI findings and clinical evolution, it is concluded that the patient has idiopathic dilated cardiomyopathy is likely secondary to peripartum cardiomyopathy. The patient is referred to the heart failure clinic and treatment is started with beta-blockers, angiotensin-converting enzyme inhibitors, spironolactone, bromocriptine, and anticoagulation. Currently in the recovery phase. PPCM is a diagnosis of exclusion in women presenting with HF due to left ventricular (LV) systolic dysfunction and should be considered when no other cause is evident. PPCM was previously defined as symptomatic HF presenting in the last month of pregnancy and up to 5 months postpartum. The diagnostic criteria indicate that LVEF is < 45% and there may or may not be ventricular dilation. Cardiac MRI is recommended for differential diagnosis, the suggested protocol is cine bSSFP for assessment of cardiac structure and function, detection of myocardial inflammation/edema using a T2-based method, detection of myocardial edema, hyperemia/capillary leak, necrosis and fibrosis using a T1-based method (e.g., EGE, T1 mapping, ECV and/or T1w LGE).
Diagnostic Techniques and Their Most Important Findings:
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