Background:
Acute pulmonary edema in pregnancy affects 0.08% of pregnant women1. The most frequent causes are cardiac pathology (26%), the use of tocolytics, excess fluid and preeclampsia. Other causes are severe infection and embolic events. Systemic lupus erythematosus (SLE) can cause valvular involvement and myocarditis with clinical significance in 10% of patients and may progress to dilated
cardiomyopathy and acute heart failure (AHF). The echocardiogram allows to distinguish between noncardiac causes and differentiate the cardiac ones in valvular, systolic or diastolic dysfunction,facilitating the etiological diagnosis and therapeutic optimization.
Case Report:
This clinical case is based on a 33 year old female, with a 35 weeks pregnancy, which went to the
emergency department with a sudden dyspnea after premature rupture of membranes. She had a known known medical history of SLE with slight involvement of the mitral valve, having abandoned follow-up consultation 5 years ago. She spontaneously stopped enoxaparin at 32nd week. The physical
examination revealed bilateral pulmonary crackles, SatO2 of 60% while breathing room air and a bloodpressure of 158 / 90mmHg. Although oxygen supplementation was started with a non rebreather mask, she remained hypoxemic. Cardiotocography revealed fetal bradycardia. Therapy with unfractionated
heparin, furosemide and hydrocortisone was started and emergency cesarean section under general anesthesia was performed. After surgery the patient was transported to the Intensive Care Unit wherean echocardiogram was preformed revealing a dilated left ventricle, ejection fraction of 20%, global hypokinesis, severe mitral regurgitation, non-dilated right cavities with good systolic function.
AHF secondary to SLE cardiomyopathy versus peripartum cardiomyopathy. Therapy with beta blocker,ACE inhibitors , furosemide, hydrocortisone and bromocriptine were initiated. There was no need forventilatory support after 24h and echocardiogram performed on the 6th day revealed improvement in FE (39%)
Discussion/Learning points:
The use of point of care echocardiography allows the orientation of the possible diagnoses. We consider
that point of care transthoracic echocardiography is a useful skill which allows the anesthesiologist to
make therapeutic decisions.

09 / Acute pulmonary oedema in pregnancy: an emerging diagnostic dilemma in a pregnant woman with systemic lupus erythematosus