Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with symptoms of heart failure occurring in the last month of pregnancy or within five months postpartum. Key symptoms include progressive dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and peripheral edema. Absence of identifiable heart disease prior to the final month of pregnancy. Left ventricular systolic dysfunction confirmed by echocardiogram (LVEF <45%).
Clinical Examination Findings
Physical examination reveals tachycardia, elevated jugular venous pressure (JVP), and S3 gallop rhythm. Pulmonary auscultation demonstrates bilateral crackles consistent with pulmonary congestion. Abdominal exam shows hepatomegaly or ascites if severe. Extremities exhibit pitting edema. Hemodynamic stability assessment: BP [ ]/ [ ], HR [ ], O2 sat [ ]%.
Treatment Protocol
Initiate guideline-directed medical therapy (GDMT) tailored for pregnancy/postpartum safety. Beta-blockers (e.g., Metoprolol succinate), diuretics for volume overload, and ACE inhibitors/ARBs (postpartum only, contraindicated in pregnancy). Consider anticoagulation if LVEF <30% or thrombus present. Bromocriptine therapy may be considered per institutional protocol. Close monitoring of hemodynamics and fluid balance.