Intraoperative Cardiac Arrest as the First Manifestation of Undiagnosed Peripartum Cardiomyopathy in a Secondary Rural Hospital: A Case Report
- 1General Practitioner, Sungai Dareh General Hospital, Dharmasraya, Indonesia
- 2Department of Cardiology, Sungai Dareh General Hospital, Dharmasraya, Indonesia
Abstract
Background: Peripartum Cardiomyopathy (PPCM) is an uncommon cause of acute heart failure occurring in late pregnancy or early postpartum. In resource-constrained hospitals without advanced cardiac support or biomarker testing, delayed recognition may lead to catastrophic complications.
Case Illustration: A 28-year-old primigravida underwent elective cesarean delivery and developed sudden Pulseless Electrical Activity (PEA) five minutes postpartum. Return of spontaneous circulation was achieved after two cycles of cardiopulmonary resuscitation. Post-arrest evaluation revealed severe global Left Ventricular (LV) systolic dysfunction (Left Ventricular Ejection Fraction [LVEF] 16%) with LV dilation (Left Ventricular Internal Diameter at end-diastole [LVIDd] 5.4 cm) and preserved Right Ventricular (RV) systolic function (Tricuspid Annular Plane Systolic Excursion [TAPSE] 2.2 cm). Emergency echocardiography was performed in the Intensive Care Unit (ICU); therefore, comprehensive hemodynamic data were limited. Inferior vena cava size was within normal limits. Hemoglobin decreased modestly (12.2 to 10.6 g/dL), and no evidence of massive hemorrhage or distributive shock was observed. In the absence of biomarker availability, diagnosis was established based on clinical echocardiographic correlation. The patient required short-term norepinephrine (0.1 mcg/kg/min for 12 hours) and dobutamine (5 mcg/kg/min for 48 hours) with gradual down-titration. Guideline-directed medical therapy was initiated after stabilization, including sacubitril–valsartan, spironolactone, bisoprolol, dapagliflozin, diuretics, and bromocriptine (5 mg twice daily for one week). LVEF improved to 34% at day 10 and recovered to 64% at three months.
Conclusions: PPCM may present as abrupt intraoperative cardiac arrest even in previously healthy women. Early echocardiography and timely heart failure therapy are critical, particularly in secondary hospitals lacking advanced diagnostic tools.
Related
- Severe Intraoperative Airway Leak Revealing Undiagnosed Mounier‐Kuhn Syndrome in an Elderly Patient
- Peripartum Cardiomyopathy in the Obstetric Intensive Care Unit: Seasonal Associations and the Impact of Winter in the Kashmir Valley
- Bromocriptine for Myocardial Recovery in Peripartum Cardiomyopathy: Design and Rationale of the REBIRTH Trial
- Bilateral postpartum renal cortical necrosis complicated by peripartum cardiomyopathy after postpartum hemorrhage: a case report
- Perioperative Management of Decompensated Peripartum Cardiomyopathy With Severe Left Ventricular Dysfunction: A Case Report.
BibTeX
@article{farid2026intraoperative,
title = {{Intraoperative Cardiac Arrest as the First Manifestation of Undiagnosed Peripartum Cardiomyopathy in a Secondary Rural Hospital: A Case Report}},
author = {Miftah Habi Farid and Rikho Ade Putera},
journal = {Majalah Kardiologi Indonesia},
year = {2026},
month = oct,
doi = {10.30701/ijc.2056},
url = {https://doi.org/10.30701/ijc.2056},
note = {CC BY},
}
RIS
TY - JOUR
TI - Intraoperative Cardiac Arrest as the First Manifestation of Undiagnosed Peripartum Cardiomyopathy in a Secondary Rural Hospital: A Case Report
AU - Miftah Habi Farid
AU - Rikho Ade Putera
PY - 2026
DA - 2026/10/25
JO - Majalah Kardiologi Indonesia
DO - 10.30701/ijc.2056
UR - https://doi.org/10.30701/ijc.2056
AB - Background: Peripartum Cardiomyopathy (PPCM) is an uncommon cause of acute heart failure occurring in late pregnancy or early postpartum. In resource-constrained hospitals without advanced cardiac support or biomarker testing, delayed recognition may lead to catastrophic complications. Case Illustration: A 28-year-old primigravida underwent elective cesarean delivery and developed sudden Pulseless Electrical Activity (PEA) five minutes postpartum. Return of spontaneous circulation was achieved after two cycles of cardiopulmonary resuscitation. Post-arrest evaluation revealed severe global Left Ventricular (LV) systolic dysfunction (Left Ventricular Ejection Fraction [LVEF] 16%) with LV dilation (Left Ventricular Internal Diameter at end-diastole [LVIDd] 5.4 cm) and preserved Right Ventricular (RV) systolic function (Tricuspid Annular Plane Systolic Excursion [TAPSE] 2.2 cm). Emergency echocardiography was performed in the Intensive Care Unit (ICU); therefore, comprehensive hemodynamic data were limited. Inferior vena cava size was within normal limits. Hemoglobin decreased modestly (12.2 to 10.6 g/dL), and no evidence of massive hemorrhage or distributive shock was observed. In the absence of biomarker availability, diagnosis was established based on clinical echocardiographic correlation. The patient required short-term norepinephrine (0.1 mcg/kg/min for 12 hours) and dobutamine (5 mcg/kg/min for 48 hours) with gradual down-titration. Guideline-directed medical therapy was initiated after stabilization, including sacubitril–valsartan, spironolactone, bisoprolol, dapagliflozin, diuretics, and bromocriptine (5 mg twice daily for one week). LVEF improved to 34% at day 10 and recovered to 64% at three months. Conclusions: PPCM may present as abrupt intraoperative cardiac arrest even in previously healthy women. Early echocardiography and timely heart failure therapy are critical, particularly in secondary hospitals lacking advanced diagnostic tools.
SN - 0126-3773
SN - 2620-4762
ER -