Peripartum Cardiomyopathy: The Unknown is Known
Prasanna Karthik Suthakaran1, Jasima Nilofer2, Kothai Gnanamoorthy3, Mohammed Idhrees4*
1Professor, Department of General Medicine, Saveetha Medical College Hospital, Chennai, India
2Department of Pathology, Sree Balaji Medical College and Hospital, Chrompet, Chennai
3Associate Professor, Department of General Medicine, ESIC Medical College and PGIMSR, India
4Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, India
Peripartum cardiomyopathy is a idiopathy cardiomyopathy associated with heart failure towards the end of pregnancy or in the postpartum period. Various mechanisms like myocarditis, autoimmune response to pregnancy, viral infections, selenium deficiency, oxidative stress and prolonged tocolysis have been proposed as the etiology. The most common presentation is acute heart failure occurring usually within a few weeks after delivery with patients developing exertional breathlessness, orthopnea and paroxysmal nocturnal dyspnea. Cardiac Magnetic Resonance Imaging is useful in accurate measurement of chamber volumes and global and segmental myocardial function. The gold standard test for diagnosis of peripartum cardiomyopathy is Endomyocardial biopsy with the histological Dallas criteria. Most of these postpartum patients are managed medically. The risk of peripartum cardiomyopathy increases with increasing parity and outcomes in subsequent pregnancies was poor.DOI: 10.29245/2578-3025/2020/4.1204 View / Download Pdf
What are Adults’ Illness Representations, Mood and Quality of Life after Myocardial Infarction?
Elizabeth Tolmie, Grace M Lindsay*, Philip Belcher
College of Nursing, Umm Al-Qura University Makkah, Kingdom of Saudi Arabia
Background: Survival after myocardial infarction (MI) is improving leading to increasing numbers of people dealing with heart health recovery, readjustment and re-investment in their future wellbeing and that of their family. Cardiac Rehabilitation (CR) aims to improve outcome by ensuring patients adopt recommended health maintenance strategies. This study explored the health maintenance needs of adults one to three years after an MI. The theoretical framework guiding the study was Leventhal’s Self Regulation Model. Data from the completion of different measures of health and illness representation are presented and the potential for measuring current health status and their explanatory factors is illuminated.
Aims: To identify the longer-term health needs of adults who have suffered an acute MI.
Methods: A mixed method design was used to explore respondents’ illness representations and the factors believed to be impacting on their longer-term health and health behaviour. A sample of 73 adults completed 3 questionnaires to assess their illness perceptions, mood and quality of life (QoL) 1 to 3 years after discharge from hospital. A sub-sample (n=30) participated in an interview, underwent a brief clinical assessment, and completed a small task. Data analysis used StatsDirect and Nudist 5.
Results: One to three years post-discharge, Personal and Treatment control belief scores of 22.6 ± 4.3 and 17.6 ± 4.3 respectively were strong, but perceived consequences high (20.6 ± 4.9). Many respondents were experiencing low energy (92%), breathlessness (67%) and chest pain (53%), and many reported a sense of loss that affected their ability to sustain health and positive health behaviour. Those with the poorest attendance at CR had poorer QoL, anxiety, and depression scores, and women had poorer outcomes than men in many of the indices assessed (p<0.05). Initial compliance with prescribed drug regimens and lifestyle recommendations (self-report) was not maintained.
Conclusion: This preliminary study supports the notion that there is a largely unmet and persistent health need among adults diagnosed with MI, and that more consideration needs to be paid to its longer-term effects and the needs of women. Combining surveys with interview methods and tools such as the PRISM+ provide an opportunity to understand the complexity of patients’ health evaluation.DOI: 10.29245/2578-3025/2020/4.1205 View / Download Pdf
Dilemma During the Pandemic- Hickam’s Dictum or Occam’s Razor?
Akanksha Agrawal1*, Deepanshu Jain2, Jefferson Baer1, Michael McDaniel1
1Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
2Center for Interventional Endoscopy, AdventHealth, Orlando, FL, USA
Coronavirus Disease 2019 (COVID-19) is a primary respiratory illness with various cardiac manifestations. This case describes a patient presenting as acute myocardial infarction (AMI) with cardiogenic shock and acute hypoxic respiratory failure secondary to COVID-19 complicated by acute embolic stroke.View / Download Pdf