27130218 Visualization

A 36- year- old Age white Personal_background woman Sex at 40 Lab_value week Lab_value of gestation Clinical_event was admitted Clinical_event to a local Nonbiological_location obstetric Nonbiological_location clinic Nonbiological_location for elective Detailed_description repeated Detailed_description cesarean Therapeutic_procedure delivery Therapeutic_procedure due to slanting Detailed_description position Detailed_description of the fetus Subject .
Both her previous History and History current History pregnancy History were History uncomplicated History .
Her past History medical History history History was History unremarkable History and no Family_history family Family_history history Family_history of Family_history cardiac Family_history disease Family_history was Family_history reported Family_history .
The caesarean Therapeutic_procedure delivery Therapeutic_procedure was performed following the administration of standard Detailed_description spinal Biological_structure anesthesia Medication .
During surgery Coreference the patient became hypotensive Sign_symptom and ephedrine Medication was injected Administration to maintain her blood Diagnostic_procedure pressure Diagnostic_procedure in the normal Lab_value range Lab_value .
Three Time hours Time after Time delivery Clinical_event of healthy Detailed_description male Detailed_description infant Subject , the patient complained of nausea Sign_symptom , increasing dyspnoea Sign_symptom and palpitations Sign_symptom .
On physical Diagnostic_procedure examination Diagnostic_procedure tachycardia Sign_symptom with ventricular Biological_structure extra Sign_symptom systoles Sign_symptom and pulmonary Biological_structure rales Sign_symptom were detected.
Her blood Diagnostic_procedure pressure Diagnostic_procedure was 80/40 Lab_value mmHg Lab_value and demanded the administration of inotropic Medication agents Medication (initially continuous Administration infusion Administration of norepinephrine Medication 0.5 Dosage mg/h Dosage followed by dobutamine Medication 7 Dosage μg/kg/min Dosage ).
Owing to worsening Lab_value of oxygen Diagnostic_procedure saturation Diagnostic_procedure up Lab_value to Lab_value 70 Lab_value % Lab_value and gradual Severity deterioration Sign_symptom of Sign_symptom consciousness Sign_symptom , mechanical Therapeutic_procedure ventilation Therapeutic_procedure was applied and the patient was transferred Clinical_event to intensive Nonbiological_location care Nonbiological_location unit Nonbiological_location .
Chest Biological_structure X Diagnostic_procedure ray Diagnostic_procedure indicated pulmonary Disease_disorder congestion Disease_disorder .
Emergency Detailed_description computer Diagnostic_procedure tomography Diagnostic_procedure excluded pulmonary Disease_disorder thromboembolism Disease_disorder ( PE Disease_disorder ) and confirmed severe Severity pulmonary Disease_disorder oedema Disease_disorder (Fig.1).
The patient received loop Medication diuretic Medication , furosemide Medication , at initial daily Dosage dose Dosage 80 Dosage mg Dosage , which was progressively Lab_value reduced Lab_value .
The diuretic Coreference was discontinued after Date 12 Date days Date of treatment.
The electrocardiogram Diagnostic_procedure disclosed sinus Sign_symptom tachycardia Sign_symptom with ST- segment Sign_symptom elevation Sign_symptom of 1,5 Lab_value mm Lab_value with negative Sign_symptom T Sign_symptom waves Sign_symptom in aVL Diagnostic_procedure and ST- segment Sign_symptom depression Sign_symptom of 1 Lab_value mm Lab_value in II Diagnostic_procedure , III Diagnostic_procedure , aVF Diagnostic_procedure , V5 Diagnostic_procedure - V6 Diagnostic_procedure (Fig.2).
Laboratory Diagnostic_procedure tests Diagnostic_procedure showed elevated Lab_value troponin Diagnostic_procedure up Lab_value to Lab_value 908 Lab_value pg/ml Lab_value (normal value <14 pg/ml), NT- pro Diagnostic_procedure BNP Diagnostic_procedure 6236 Lab_value pg/ml Lab_value (normal value <125 pg/ml).
The bedside Detailed_description transthoracic Diagnostic_procedure echocardiography Diagnostic_procedure ( TTE Diagnostic_procedure ) revealed severe Severity left Biological_structure ventricular Biological_structure ( LV Biological_structure ) systolic Disease_disorder dysfunction Disease_disorder .
Therefore the patient was transferred Clinical_event to Intensive Biological_structure Cardiac Biological_structure Therapy Biological_structure Clinic Biological_structure .
Repeated TTE Diagnostic_procedure showed LV Biological_structure ejection Diagnostic_procedure fraction Diagnostic_procedure 30 Lab_value % Lab_value with hypokinesis Sign_symptom of the mid Detailed_description and Detailed_description basal Detailed_description segments Detailed_description of posterior, Biological_structure anterior Biological_structure and Biological_structure lateral Biological_structure wall Biological_structure with preserved Lab_value contractility Diagnostic_procedure of the apical Biological_structure segments Biological_structure .
Urgent Detailed_description coronary Diagnostic_procedure angiography Diagnostic_procedure presented normal Lab_value coronary Biological_structure arteries Biological_structure .
The diagnosis of inverted Detailed_description stress- induced Detailed_description cardiomyopathy Disease_disorder was set upon the overall clinical data.
After Date 3 Date days Date the patient was weaned from respirator Therapeutic_procedure and extubated Therapeutic_procedure .
Following hemodynamic Diagnostic_procedure improvement Lab_value , inotropic Medication agents Medication were tapered gradually.
Both TTE Diagnostic_procedure and magnetic Diagnostic_procedure resonance Diagnostic_procedure imaging Diagnostic_procedure (Figs.3 and ​4) performed on Date the Date fifth Date day Date showed complete Lab_value recovery Lab_value of myocardial Diagnostic_procedure function Diagnostic_procedure .
The patient was discharged Clinical_event after Date 15 Date days Date in good Lab_value overall Diagnostic_procedure condition Diagnostic_procedure .
At 12- month Date follow- up Clinical_event she remained asymptomatic Sign_symptom with no echocardiographic Sign_symptom abnormalities Sign_symptom .