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CC BY-NC-ND 4.0 · AJP Rep 2020; 10(02): e165-e168
DOI: 10.1055/s-0040-1712926
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Heart Failure with Preserved Ejection Fraction in a Postpartum Patient with Superimposed Preeclampsia and COVID-19

Rachel G. Sinkey
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
2   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Indranee Rajapreyar
3   Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
,
Lindsay S. Robbins 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
2   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Jodie Dionne-Odom
4   Division of Infectious Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
,
Steven M. Pogwizd
3   Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
,
Brian M. Casey
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
2   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Alan T.N. Tita
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
2   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
› Author Affiliations
Further Information

Publication History

20 April 2020

30 April 2020

Publication Date:
04 June 2020 (online)

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Abstract

Our understanding of COVID-19 in pregnant and postpartum women is rapidly evolving. We present a case from March 2020 of a 25-year-old G2P2002 whose delivery was complicated by preeclampsia with severe features who presented to the emergency department 9 days after cesarean delivery with chest tightness and dyspnea on exertion. On presentation she had severe hypertension, pulmonary edema, elevated brain natriuretic peptide, and high-sensitivity troponin-I, suggesting a diagnosis of hypertensive emergency leading to heart failure with a preserved ejection fraction resulting in pulmonary edema and abnormal cardiac screening tests. However, bilateral opacities were seen on a computed tomography of the chest, and COVID-19 testing was positive. A high index of suspicion for both COVID-19 and cardiovascular complications are critical for optimal patient outcomes and protection of health care workers.

Keywords

COVID-19 - heart failure with preserved ejection fraction - hypertensive emergency - preeclampsia
 

  • References

  • 1 Zhu N, Zhang D, Wang W. , et al; China Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; 382 (08) 727-733
    CrossrefPubMedGoogle Scholar
  • 2 Johns Hopkins University Coronavirus Resource Center. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. Available at: https://coronavirus.jhu.edu/map.html . Accessed April 18, 2020
    PubMedGoogle Scholar
  • 3 Driggin E, Madhavan MV, Bikdeli B. , et al. Cardiovascular considerations for patients, health care workers, and health systems during the coronavirus disease 2019 (COVID-19) pandemic. J Am Coll Cardiol 2020; ;S0735-1097(20)34637-4 (e-pub ahead f print) DOI: 10.1016/j.jacc.2020.03.031.
    CrossrefPubMedGoogle Scholar
  • 4 Reddy YNV, Carter RE, Obokata M, Redfield MM, Borlaug BAA. A simple, evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction. Circulation 2018; 138 (09) 861-870
    CrossrefPubMedGoogle Scholar
  • 5 Glover AV, Tita A, Biggio JR, Anderson SB, Harper LM. Incidence and risk factors for postpartum severe hypertension in women with underlying chronic hypertension. Am J Perinatol 2019; 36 (07) 737-741
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Whelton PK, Carey RM, Aronow WS. , et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Hypertension 2018; 71 (06) 1269-1324
    CrossrefPubMedGoogle Scholar
  • 7 Oktay AA, Shah SJ. Diagnosis and management of heart failure with preserved ejection fraction: 10 key lessons. Curr Cardiol Rev 2015; 11 (01) 42-52
    PubMedGoogle Scholar
  • 8 Zhang S, Li H, Huang S, You W, Sun H. High-resolution CT features of 17 cases of corona virus disease 2019 in Sichuan province, China. Eur Respir J 2020; (e-pub ahead of print) DOI: 10.1183/13993003.00334-2020.
    CrossrefPubMedGoogle Scholar
  • 9 Shi H, Han X, Jiang N. , et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis 2020; 20 (04) 425-434
    CrossrefPubMedGoogle Scholar
  • 10 Ather S, Chan W, Bozkurt B. , et al. Impact of noncardiac comorbidities on morbidity and mortality in a predominantly male population with heart failure and preserved versus reduced ejection fraction. J Am Coll Cardiol 2012; 59 (11) 998-1005
    CrossrefPubMedGoogle Scholar
  • 11 Bhatraju PK, Ghassemieh BJ, Nichols M. , et al. Covid-19 in critically ill patients in the Seattle region - case series. N Engl J Med 2020
    PubMedGoogle Scholar
  • 12 Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential effects of coronaviruses on the cardiovascular system: a review. JAMA Cardiol 2020
    PubMedGoogle Scholar
  • 13 Li SS, Cheng CW, Fu CL. , et al. Left ventricular performance in patients with severe acute respiratory syndrome: a 30-day echocardiographic follow-up study. Circulation 2003; 108 (15) 1798-1803
    CrossrefPubMedGoogle Scholar
  • 14 Zhou F, Yu T, Du R. , et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395 (10229): 1054-1062
    CrossrefPubMedGoogle Scholar
  • 15 Smith GN, Louis JM, Saade GR. Pregnancy and the postpartum period as an opportunity for cardiovascular risk identification and management. Obstet Gynecol 2019; 134 (04) 851-862
    CrossrefPubMedGoogle Scholar