Cardiomyopathy-Case 2
A 32-year-old woman was admitted to the high-risk perinatal unit at 31 weeks' gestation with d)"lpnea and fatigue. She had bilateral, basilar crackles, and her oxygen saturation via pulse oximetrywas 88%. An echocardiogram showed a markedly dilated left ventricle with diffuse hypokinesis and an ejection fraction of 20% to 25%.
A pulmonary artery catheter was placed and the following parameters were obtained:
A dobutamine infusion was initiated at 5 mcg/kg/ min and oxygen was applied at 6 Umin via nasal cannula.
'The moat likely medical diagnosis for this patient is:
(A) Hypertrophic obstructive cardiomyopathy
{B) Restrictive cardiomyopathy
(C) Peripartum cardiomyopathy
(D) Idiopathic cardiomyopathy
Her hemodynamic profile indicates a low Cl with pouible volume overload as evidenced by:
(A) PA pressure 48/26 mmHg
(B) Elevated RAP (12 mm Hg) and PAOP (24 mm Hg)
(C) EF 20% to 25%
(D) Spo2 88%
Your plan of care for this patient includes which of the following:
{A) Improve oxygen delivery to the tissues
(B) Increase myocardial contractility
(C) Careful management of preload as blood volume is normally 1.5 times higher during pregnancy
(D) Education about self-management of heart failure and coping strategies
{E) All of the above