Introducing a ۴۰-year-old woman, ۱۶ weeks pregnant, with shortness of breath due to heart failure after contracting Covid-۱۹

مقدمه : Coronavirus disease ۲۰۱۹ (COVID-۱۹) rapidly spread around the world becoming a global public health emergency.Although COVID-۱۹ was initially considered a respiratory disease, it has rapidly become clear that a multiorgan involvement was common. In particular, the heart often represents a target organ and patients may develop heart failure (HF). Patients hospitalized for HF during the pandemic were sicker, with higher rates of NYHA class III or IV symptoms and severe peripheral edema, which are known predictors of poor outcomes in acute HF. Cardiac disease complicating pregnancy is categorized as an ‘indirect’ cause of maternal mortality, meaning that it is unrelated to any complication of the pregnancy itself. Cardiomyopathy is generally the commonest cause of mortality developing during or after pregnancy.هدف : We reported a ۴۰ year old woman with heart failure and ۱۶ weeks pregnancy.معرفی بیمار: The patient was a ۴۰-year-old woman who contracted Covid-۱۹ about ۶ months ago and was hospitalized with symptoms of shortness of breath and edema of the limbs. She had injected Sinopharm vaccine twice, the second dose was about a week .Vital sign was stable and BP: ۱۲۰/۸۰ , HR: ۶۹, RR: ۱۸, BT: ۳۶.۸, Spo۲:۹۵% was reported. Lab tests were in normal ranges, troponin was ۰.۰۰۳ and ckmb: ۱۱.in ECG we see PVC bigeminated.lung CT scan showed grand glasses pattern and mild bilateral pleural effusion.in echocardiography LV EF:۲۰%, Mod MR and severe LV systolic Dysfunction was reported.The patient with prescriptions: Valsartan, ASA, Lasix, Eplernone, Gloripa, amiodarone Was discharged from hospital.After discharge, the patient was monitored by echocardiography and was under medical treatment. After ۶ months the patient's symptoms worsened. Also she suffers from AUB and dysmenorrhea. An ultrasound was requested for the patient and it was found that she is pregnant. She was ۱۶ weeks pregnant with a live female fetus and G۵ P۳ AB۱. The patient was referred to a cardiologist and admitted to the cardiac intensive care unit. All the patient's previous medications were discontinued and replaced with new medications including hydralazine and Bisoprolole. In echocardiography LV EF: ۲۵%, Mod MR, mod LV enlargement, severe LV systolic Dysfunction and global LVH were reported. Considering that the patient's life was in danger, she was a candidate for abortion.After receiving the forensic medical license, the patient began to give birth under the supervision of a gynecologist using misoprostol suppository and finally underwent curettage due to incomplete abortion.After the abortion, the patient was admitted to the hospital for ۲ weeks and was finally discharged with medication orders and recommendations to perform cardiac angiography and MRI and to choose a reliable method to prevent pregnancy.

کلیدواژه ها:

Heart Failure ، COVID۱۹ ، PREGNANCY ، Cardiac disease