Mixed Cardiogenic and Septic Shock in a Postpartum Patient: Coexisting Postpartum and Septic Cardiomyopathy: A Rare Case Report

Background: Postpartum cardiomyopathy (PPCM) presents in late pregnancy or the postpartum period and is a rare, sometimes fatal cause of idiopathic heart failure. Septic cardiomyopathy is a reversible impairment of myocardial function occurring with severe sepsis. The coexistence of PPCM and septic cardiomyopathy during the postpartum period is uncommon. Maternal mortality and cardiovascular instability have been reported to be severe, and the mortality rate among women with this phenomenon is known to be high. Case Presentation: A 31-year-old woman, who was already receiving maintenance with two I/V fluids following LSCS for uterine rupture, developed breathlessness with associated diaphoresis and global hypokinesis. She collapsed with a blood pressure of 90/60 mmHg and a rate of 120/min at 3 hrs post OP and was later shifted to the ICCU with a diagnosis of mixed cardiogenic and septic shock. Echo showed global LV hypokinesis, LV dilation of 64 mm, LA diameter of 42 mm, low LVEF of 30-35%, and mild-to-moderate MR. Marked leucocytosis of 31,000/L and thrombocytopenia of 38,000/L pointed towards sepsis. A known history of PPCM in the previous pregnancy had not been disclosed. She was given the inotrope Dobutamine and the vasopressors Noradrenaline and high-dose Adrenaline, together with broad-spectrum antibiotics Piperacillin/Tazobactam and Levofloxacin, and was aggressively diuresed with Furosemide; her haemodynamic status improved within 5 days in hospital. Conclusion: This case illustrates the importance of a detailed obstetric history and the relative rarity of coexisting PPCM and septic cardiomyopathy. Expedited diagnostic echo and aggressive, tailored cardiotonic and sepsis management were probably essential to the successful management of this case of postpartum cardiogenic collapse.