Peripartum Cardiomyopathy...does your unit regularly assess for this *and*

[carachel2]

include warning signs and symptoms as part of regular discharge teaching to post-partum mothers ?

I am a PPCM survivor and a cardiac nurse and belong to a website for survivors of PPCM. So many of us have been misdiagnosed or delayed with a diagnosis....we have realized that making sure Ob-Gyn nurses are tuned into this disease as a differential diagnosis is our best bet towards early diagnosis.

So let me know your stories. Would you recognize it ? Has your unit seen a PPCM patient ? Do you have questions ?

[NPinWCH]

I've been an OB nurse for more than 12 years and I've seen 2 pts with PP cardiomyopathy. One that was diagnosed almost immediately after delivery and another who wasn't diagnosed for about 3 weeks after delivery. The problem with diagnosis is that it often depends on the severity of the disease and/or how quickly in progresses.

The first pt was preeclamptic, went into HELLP syndrome, had blood and platelet transfusions, emergent c/s and was thought to have cardiomyopathy based mostly on cardiac arrythmias. That diagnosis was confirmed after she was transferred to a tertiary facility. This woman had the benefit of having major risk factors, and being sick enough to require intensive care and cardiac monitoring, and her disease progressed quickly enough for us to see it clearly. We also were "looking" for complications.

My other patient had a spontaneous lady partsl delivery after arriving to our unit with limited prenatal care in another state. Her hgb was only 9 on admission and she bled a bit heavy afterwards, received extra fluids and her hgb on discharge was 7. She wanted to go home in under 24 hours, but the doc refused because of her low hgb. She really didn't complain much, but was having dyspnea with exertion and was really tired. She smoked about 1 1/2 ppd and she had some occasional wheezing/rales when her lungs were auscultated.

I remember documenting this, and informing the doc, who of course told me, "Well, what do you expect from someone who doesn't take her vitamins, looses blood and smokes almost 2 ppd?" All of which is true, which is why her diagnosis didn't occur for about 3 weeks, when she showed up in the docs office for her pp visit with increased edema, weakness and extreme dyspnea.

The biggest problem with teaching on discharge and diagnosis is that many of the sx are similar to normal pp findings. With the exception of extreme dyspnea/orthotic dyspnea, hemoptysis and chest pain the other sx can often be attributed to other causes. Many women don't have ALL the sx, or they have other more common problems that may hide the diagnosis (caring for a new baby/blood loss/low hgb=fatigue and dyspnea).

One of my nursing instructors always said, "It's always better to look for hay in a haystack, but keep in mind that sometimes there IS a needle." Luckily, most of the time it really is the "hay" causing the problem. I always keep cardiomyopathy in the back of my head. Discharge teaching includes SOB, chest pain and unexplained abd. pain as "Call doc/911 right away" sx, but apart from that we don't have specific info on cardiomyopathy.

[crissrn27, RN]

We have only had 1 pt with PPCM. It was a very scary situation, mom in ICU and eventually shipped to a larger hospital. We delivered the baby via C-sec and shipped her to the other hopital. I remember setting up the stabilet in the ICU because she was in labor. She was heavily sedated and vented, I just knew that baby was going to be a bad baby. Thank goodness she stablized enough to section. She was very sick for a while, and from the reports I have heard she still is having trouble 12 months after the fact. I don't do moms (work in nursery), and I'm not sure what they look for in L and D and PP.

I also had a friend (an LPN) that had PPCM. She had HELLP, ended up with a heart-lung transplant when the baby was 15 months old, and a kidney transplant when the baby was 2y/o. She died a few months after the kidney transplant. She never even went home after the baby was born. Was in the hospital the whole time (from a few weeks antepartum until she died). It was so sad. She also had a 6y/o. Thank you for bringing this up, it is so important.

[LizzyL&DRN]

We had a mom that had a pre-exisisting cardiac problem prior to her pregnancy that she knew about(can't remember the exact dx). The doctors apparently told her she shouldn't have anymore children due to her heart condition. She ignored their advice, got pregnant and stopped taking her cardiac medications and never told her ob/gyn about her condition. She was a scheduled repeat c section and of course they just poured the IV fluids in during surgery like they always do because they didn't know better. The first PP day, she suddenly c/o extreme SOB, dyspnea and coded right there on our PP floor. She died. Had she only told someone about her condition she probably would have been fine. So sad, and I believe her 8 year old daughter was at the bedside when it all happened.

[SmilingBluEyes]

Good subject. Since this is a great opportunity for education, I encourage anyone with knowledge provide us with links to articles/information regarding this rare condition.

Thank you.

[crissrn27, RN]

sorry, that link was not so good, I hadn't been to the page in a while and it hasn't been updated in forever, so I removed it. I'll try to find another.

[crissrn27, RN]

http://www.geocities.com/ppcmfriend/wip.html

OK, this explains it fairly well. Not much on the subject to be found.