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Rev Bras Ginecol Obstet 2016; 38(06): 308-313
DOI: 10.1055/s-0036-1584567
Case Report
Thieme Publicações Ltda Rio de Janeiro, Brazil

Peripartum Cardiomyopathy Treatment with Dopamine Agonist and Subsequent Pregnancy with a Satisfactory Outcome

Tratamento da miocardiopatia periparto com agonista dopaminérgico e subsequente gestação com resultado satisfatório
Maria Adélia Medeiros e Melo
1   Fetal Medicine Service, Maternidade-Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, CE, Brazil
,
Jordão Sousa Carvalho
1   Fetal Medicine Service, Maternidade-Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, CE, Brazil
,
Francisco Edson de Lucena Feitosa
1   Fetal Medicine Service, Maternidade-Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, CE, Brazil
,
Edward Araujo Júnior
2   Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
,
Alberto Borges Peixoto
2   Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
,
Francisco Herlânio Costa Carvalho
1   Fetal Medicine Service, Maternidade-Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, CE, Brazil
,
Regina Coeli Marques Carvalho
1   Fetal Medicine Service, Maternidade-Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, CE, Brazil
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Weitere Informationen

Publikationsverlauf

16. Januar 2016

03. Mai 2016

Publikationsdatum:
11. Juli 2016 (online)

   Lizenzen und Reprints

Abstract

Pathophysiological mechanisms of peripartum cardiomyopathy are not yet completely defined, although there is a strong association with various factors that are already known, including pre-eclampsia. Peripartum cardiomyopathy treatment follows the same recommendations as heart failure with systolic dysfunction. Clinical and experimental studies suggest that products of prolactin degradation can induce this cardiomyopathy. The pharmacological suppression of prolactin production by D2 dopamine receptor agonists bromocriptine and cabergoline has demonstrated satisfactory results in the therapeutic response to the treatment. Here we present a case of an adolescent patient in her first gestation with peripartum cardiomyopathy that evolved to the normalized left ventricular function after cabergoline administration, which was used as an adjuvant in cardiac dysfunction treatment. Subsequently, despite a short interval between pregnancies, the patient exhibited satisfactory progress throughout the entire gestation or puerperium in a new pregnancy without any cardiac alterations. Dopamine agonists that are orally used and are affordable in most tertiary centers, particularly in developing countries, should be considered when treating peripartum cardiomyopathy cases.

Resumo

Os mecanismos fisiopatológicos da miocardiopatia periparto ainda não são totalmente definidos, apesar de haver forte associação com vários fatores já conhecidos, incluindo a pré-eclâmpsia. O tratamento segue as mesmas recomendações para a insuficiência cardíaca com disfunção sistólica. Estudos clínicos e experimentais recentes sugerem que os produtos de degradação da prolactina podem induzir a miocardiopatia. A supressão farmacológica da produção de prolactina por agonista do receptor D2 da dopamina, bromocriptina ou cabergolina, vem demonstrando resultados satisfatórios na resposta terapêutica do tratamento. Apresentamos o relato de uma primigesta, adolescente, com miocardiopatia periparto que evoluiu para a normalização da função ventricular esquerda após a administração da cabergolina, utilizada como adjuvante na terapêutica da disfunção cardíaca. Subsequentemente, apesar do intervalo entre as gestações ser considerado curto, apresentou evolução satisfatória em uma nova gestação sem qualquer alteração cardíaca durante todo o período gestacional ou puerpério. Os agonistas dopaminérgicos, drogas de uso oral e de preço acessível para a maioria dos centros terciários, em particular em países subdesenvolvidos, não podem ser esquecidos frente a casos de miocardiopatia periparto.

Keywords

peripartum cardiomyopathy - congestive heart failure - dopamine agonists - pregnancy outcome

Palavras-chave

miocardiopatia periparto - falência cardíaca congestiva - agonistas dopaminérgicos - resultado da gravidez
 

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