Peri-partum cardiac failure
Stein, G.S.; Morton, J.; Keating, P.
Lancet 1(8075): 1214
1978
ISSN/ISBN: 0140-6736 PMID: 77984 Document Number: 133161
Peri-partum cardiac failure (PPCF) was studied in 224 women seen over 3 yr in Zaria, in northern Nigeria. A very high proportion were rural Hausa patients. A seasonal peak occurred in July and the incidence was .apprx. 1% of deliveries. Risk increased with age and parity. Most common symptoms began in the 2nd wk after delivery and admission was most frequently in the 4th wk. Typical signs of cardiac failure with pulsus alternans, atrio-ventricular valvular incompetence, transient systemic hypertension and splenomegaly were common. Chest radiograph showed marked cardiomegaly and extrasystoles and inverted T waves were often present in the ECG. Hypoalbuminemia was common. Digoxin and diuretics were rapidly effective, causing a mean weight loss of 29% in 15 days, resolution of hypertension and a fall in the cardio-thoracic ratio (CTR) from 61-53%. During the 1st year following initiation of therapy, CTR returned to normal in 82% of patients, and ECG in 60%. PPCF recurred with the same seasonal variation, in 19% of subsequent pregnancies. During 2-5 yr follow-up 22% of the women became hypertensive and 11% died. Prognosis was least favorable in those with an arrhythmia, hypertension, sustained cardiomegaly or age of 30 or more. Asymptomatic post-partum hypertension (PPHT) occurred in 61% of normal Hausa women, with a seasonal peak in May, especially in those with hypertension during pregnancy or labor and twin pregnancies. Peri-partum cardiac failure may be due to the combination of pressure load of PPHT, volume load from eating Na-rich kanwa and the cardiovascular demands of heat, climatic and traditionally self-imposed.