Peripartum Kardiyomiyopati Tanısında Hemşirelik Bakımı

Yıl 2024, Cilt: 7 Sayı: 3, 258 - 264, 27.09.2024

Filiz Selen

https://doi.org/10.53493/avrasyasbd.1441478

Öz

Kardiyomiyopati, gözlenen miyokard anormalliğine neden olabilecek başka hastalıkların yokluğunda kalp kasının yapısal ve işlevsel olarak anormal olduğu bir patolojik durumdur. Peripartum kardiyomiyopati (PPKM) ise bilinen kalp hastalığı olmayan kadınlarda hamileliğin sonlarına doğru veya doğum sonrası ilk aylarda gelişen sol ventrikül ejeksiyon fraksiyonunun (LVEF) <45% olması ile karakterize idiyopatik bir kardiyomiyopatidir. Seyrek görülmekle birlikte gebelikteki kardiyovasküler komplikasyonların ağır seyreden nedenlerini oluşturmaktadır. Presipitan faktörler arasında çoğul gebelik, çoğul doğum, genetik yatkınlık, etnik köken, sigara/alkol kullanımı, hipertansif ve metabolik bozukluklar, ileri maternal yaş gebeliği ve uzun süreli beta bloker kullanımı olduğu bildirilmektedir. Olgular nefes darlığı, çarpıntı hissi, baş dönmesi, ortopne, paroksismal noktürnal dispne ve ödem dahil olmak üzere kalp yetmezliği semptomları ile kliniğe başvurmaktadır. Bu semptomlar birçok yönden son trimestır veya peripartum dönemin normal bulgularına benzemesi nedeniyle tanıda gecikmeler görülmektedir. Fetal ve maternal etkileri nedeniyle erken tanı, tedavi ve bakım sürecinin başlatılması önerilmektedir. Gebelik sonrasında ya da ardıl gebeliklerde de olası komplikasyon olasılığın yüksek olması nedeniyle bireylerin öz bakım becerilerinin artırılması ve yaşam biçimi düzenlemelerine ilişkin hemşireler tarafından profesyonel bir danışmanlık desteği alması gerekmektedir. Alanyazında, olası komplikasyon riski yüksek olan peripartum kardiyomiyopati tanısı olan bireylere yönelik kanıta dayalı hemşirelik girişimlerinin incelendiği kaynakların kısıtlılığı nedeniyle bu çalışmada, sistematik ve profesyonel bir hemşirelik bakım planı aktarılması amaçlanmıştır.

Anahtar Kelimeler

Kardiyomiyopati, peripartum, hemşirelik

Nursing Care in the Diagnosis of Peripartum Cardiomyopathy

Öz

Cardiomyopathy is a pathological condition in which the heart muscle is structurally and functionally abnormal in the absence of other diseases that could cause the observed myocardial abnormality. Peripartum cardiomyopathy (PCPC) is an idiopathic cardiomyopathy characterized by a left ventricular ejection fraction (LVEF) <45% that develops late in pregnancy or in the first months postpartum in women without known heart disease. Although it is rare, it is the leading cause of severe cardiovascular complications in pregnancy. Precipitating factors include multiple pregnancy, multiple births, genetic predisposition, ethnicity, smoking/alcohol use, hypertensive and metabolic disorders, advanced maternal age pregnancy and long-term beta blocker use. Pregnant women present to the clinic with symptoms of heart failure, including dyspnea, palpitations, dizziness, orthopnea, paroxysmal nocturnal dyspnea and edema. Because these symptoms resemble in many ways the normal findings of the last trimester or peripartum period, there is a delay in diagnosis. Because of the fetal and maternal effects, early diagnosis, treatment and initiation of care are recommended. Due to the high likelihood of possible complications after pregnancy or in subsequent pregnancies, individuals should receive professional counseling support by nurses to increase their self-care skills and lifestyle arrangements. Due to the limited literature on evidence-based nursing interventions for individuals diagnosed with peripartum cardiomyopathy with a high risk of possible complications, this study aimed to provide a systematic and professional nursing care plan.

Anahtar Kelimeler

Cardiomyopathy, peripartum, nursing

Kaynakça

• Bubshait JA, Shanei SA. (2024). An unusual presentation of peripartum cardiomyopathy complicated by a pulmonary embolism: A case report. Cureus, 16(1): e51768. doi: 10.7759/ cureus.51768.
• Bubshait JA, Shanei SA. (2024). An unusual presentation of peripartum cardiomyopathy complicated by a pulmonary embolism: A case report. Cureus, 16(1): e51768. doi: 10.7759/ cureus.51768.
• Carlson S, Schultz J, Ramu B, Davis MB. (2023). Peripartum cardiomyopathy: Risks diagnosis and management. J Multidiscip Healthc, 16: 1249-1258. doi: 10.2147/JMDH. S372747.
• Carlson S, Schultz J, Ramu B, Davis MB. (2023). Peripartum cardiomyopathy: Risks diagnosis and management. J Multidiscip Healthc, 16: 1249-1258. doi: 10.2147/JMDH. S372747.
• Carpenito-Moyet, L.J. (2010) Handbook of Nursing Diagnosis. 13th Edition, Lippincott Williams and Wilkins, Philadelphia.
• Carpenito-Moyet, L.J. (2010) Handbook of Nursing Diagnosis. 13th Edition, Lippincott Williams and Wilkins, Philadelphia.
• Demakis JG, Rahimtoola SH. (1971). Peripartum cardiomyopathy. Circulation, 44: 964–8. doi: 10.1161/01.cir.44.5.964.
• Demakis JG, Rahimtoola SH. (1971). Peripartum cardiomyopathy. Circulation, 44: 964–8. doi: 10.1161/01.cir.44.5.964.
• Elkayam U. (2014). Risk of subsequent pregnancy in women with a history of peripartum cardiomyopathy. J Am Coll Cardiol, 64(15):1629-1636. doi:10.1016/j.jacc.2014.07.961.
• Elkayam U. (2014). Risk of subsequent pregnancy in women with a history of peripartum cardiomyopathy. J Am Coll Cardiol, 64(15):1629-1636. doi:10.1016/j.jacc.2014.07.961.
• Kayıkçıoğlu M, Tokgözoğlu L, Mutluer FO, Ural D, Biteker M. (2018). The rationale and design of the national peripartum cardiomyopathy registries in Turkey: The ARTEMIS-I and ARTEMIS-II studies. Turk Kardiyol Dern Ars, 46(1): 39-46. doi: 10.5543/tkda.2018.53248.
• Kayıkçıoğlu M, Tokgözoğlu L, Mutluer FO, Ural D, Biteker M. (2018). The rationale and design of the national peripartum cardiomyopathy registries in Turkey: The ARTEMIS-I and ARTEMIS-II studies. Turk Kardiyol Dern Ars, 46(1): 39-46. doi: 10.5543/tkda.2018.53248.
• Manolio TA, Baughman KL, Rodeheffer R, Pearson TA, Bristow JD, Michels VV, Abelmann WH, Harlan WR. (1992). Prevalence and etiology of idiopathic dilated cardiomyopathy (summary of a National Heart, Lung, and Blood Institute workshop). Am J Cardiol, 69: 1458–66. doi: 10.1016/0002-9149(92)90901-A.
• Manolio TA, Baughman KL, Rodeheffer R, Pearson TA, Bristow JD, Michels VV, Abelmann WH, Harlan WR. (1992). Prevalence and etiology of idiopathic dilated cardiomyopathy (summary of a National Heart, Lung, and Blood Institute workshop). Am J Cardiol, 69: 1458–66. doi: 10.1016/0002-9149(92)90901-A.
• Mahowald MK, Basu N, Subramaniam L, Scott R, Davis MB. (2019). Long-term outcomes in peripartum cardiomyopathy. The Open Cardiovascular Medicine Journal, 13(1): 13-23. doi: 10.2174/1874192401913010013.
• Mahowald MK, Basu N, Subramaniam L, Scott R, Davis MB. (2019). Long-term outcomes in peripartum cardiomyopathy. The Open Cardiovascular Medicine Journal, 13(1): 13-23. doi: 10.2174/1874192401913010013.
• McNamara DM, Elkayam U, Alharethi R, Damp J, Hsich E, Ewald G, Modi K, Alexis JD, Ramani GV, Semigran MJ, Haythe J, Markham DW, Marek J, Gorcsan J 3rd, Wu WC, Lin Y, Halder I, Pisarcik J, Cooper LT, Fett JD; IPAC Investigators. (2015). Clinical outcomes for peripartum cardiomyopathy in North America: Results of the IPAC study (Investigations of Pregnancy-Associated Cardiomyopathy). J Am Coll Cardiol, 25; 66(8):905-14. doi: 10.1016/j.jacc.2015.06.1309.
• McNamara DM, Elkayam U, Alharethi R, Damp J, Hsich E, Ewald G, Modi K, Alexis JD, Ramani GV, Semigran MJ, Haythe J, Markham DW, Marek J, Gorcsan J 3rd, Wu WC, Lin Y, Halder I, Pisarcik J, Cooper LT, Fett JD; IPAC Investigators. (2015). Clinical outcomes for peripartum cardiomyopathy in North America: Results of the IPAC study (Investigations of Pregnancy-Associated Cardiomyopathy). J Am Coll Cardiol, 25; 66(8):905-14. doi: 10.1016/j.jacc.2015.06.1309.
• Sliwa K, Mebazaa A, Hilfiker-Kleiner D, Petrie MC, Maggioni AP, Laroche C, Regitz-Zagrosek V, Schaufelberger M, Tavazzi L, van der Meer P, Roos-Hesselink JW, Seferovic P, van Spandonck-Zwarts K, Mbakwem A, Böhm M, Mouquet F, Pieske B, Hall R, Ponikowski P, Bauersachs J. (2017). Clinical characteristics of patients from the worldwide registry on peripartum cardiomyopathy (PPCM): EURObservational Research Programme in conjunction with the Heart Failure Association of the European Society of Cardiology Study Group on PPCM. Eur J Heart Fail, 19(9): 1131-1141. doi: 10.1002/ejhf.780.
• Sliwa K, Mebazaa A, Hilfiker-Kleiner D, Petrie MC, Maggioni AP, Laroche C, Regitz-Zagrosek V, Schaufelberger M, Tavazzi L, van der Meer P, Roos-Hesselink JW, Seferovic P, van Spandonck-Zwarts K, Mbakwem A, Böhm M, Mouquet F, Pieske B, Hall R, Ponikowski P, Bauersachs J. (2017). Clinical characteristics of patients from the worldwide registry on peripartum cardiomyopathy (PPCM): EURObservational Research Programme in conjunction with the Heart Failure Association of the European Society of Cardiology Study Group on PPCM. Eur J Heart Fail, 19(9): 1131-1141. doi: 10.1002/ejhf.780.
• Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, Regitz-Zagrosek V, Schaufelberger M, Tavazzi L, van Veldhuisen DJ, Watkins H, Shah AJ, Seferovic PM, Elkayam U, Pankuweit S, Papp Z, Mouquet F, McMurray JJ; Heart Failure Association of the European Society of Cardiology Working Group on Peripartum Cardiomyopathy. (2010). Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail, 12(8): 767-78. doi: 10.1093/eurjhf/hfq120.
• Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, Regitz-Zagrosek V, Schaufelberger M, Tavazzi L, van Veldhuisen DJ, Watkins H, Shah AJ, Seferovic PM, Elkayam U, Pankuweit S, Papp Z, Mouquet F, McMurray JJ; Heart Failure Association of the European Society of Cardiology Working Group on Peripartum Cardiomyopathy. (2010). Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail, 12(8): 767-78. doi: 10.1093/eurjhf/hfq120.
• Wilkinson, J. M., Barcus, L. (2016). Pearson nursing diagnosis handbook. 11thed., Pearson, United States.
• Wilkinson, J. M., Barcus, L. (2016). Pearson nursing diagnosis handbook. 11thed., Pearson, United States.