The editor warmly reminds that music is more enjoyable~
Zhuang Xiaofeng
On a sunny winter afternoon, Tingting (pseudonym) came to the heart failure specialty clinic. She hugged the baby who was about to turn one year old in her arms and showed me the baby's cute appearance. The sleeping child, with a pacifier in his mouth, does not know when he will get to know his mother
The hardships that we have experienced in the past year.
I checked Tingting's cardiac ultrasound report, and from the left ventricular size and ejection fraction and the values of important markers of heart failure in the report, it can be seen that her heart has shrunk a little compared to before, the ejection fraction has increased a little, and the values are close to normal.
I was genuinely delighted. It was with the joint efforts of both doctors and patients that Tingting was able to recover her health step by step.
Attacked by disease
Tingting is a primary school music teacher, before her illness, she loved life, was optimistic, and looked forward to the arrival of her children with her husband. After Tingting became pregnant, the couple, like many young couples, took artistic photos of pregnancy, and everything was so beautiful. However, there are inevitably misfortunes in life.
In the 36th week of pregnancy, Tingting felt extremely tired, and when she went to the hospital for a pregnancy test, she felt very difficult to climb two or three floors. At first, she thought it was just the third trimester discomfort, but as breathlessness and swelling in her ankles worsened, she realized that it might not be good. After visiting the hospital, Tingting was diagnosed with perinatal cardiomyopathy. The news shocked her and her family.
Perinatal cardiomyopathy is a special type of cardiomyopathy in clinical practice, which occurs in the last month of pregnancy or within five months after childbirth, and the main symptom of patients is heart failure. At present, the cause of the disease is not well understood. After giving birth to the child by cesarean section, Tingting's condition became more serious and she was transferred to Fuwai Hospital of the Chinese Academy of Medical Sciences and admitted to the heart failure care unit.
Since then, I have served as her attending physician.
Facing teammates to leave
When Tingting first arrived, she was extremely depressed. Her heart was particularly enlarged and her symptoms were severe, but she refused all kinds of invasive treatments. Only when asked about the child's health will she proudly and joyfully say, "Baby is healthy!" At this time, her face overflowed with happiness, like a ray of sunlight shining into the hazy sky, and it instantly became bright and brilliant.
I patiently explained the characteristics of perinatal cardiomyopathy to Tingting and discussed with her a personalized treatment plan. According to the latest guidelines at home and abroad, the drug treatment of patients with acute onset can be summarized as "BOARD", that is, bromocriptin (B), oral anti-heart failure drugs (O), anticoagulants (A), vasodilators (R) and diuretics (D). These medications can help patients with remission. Through many doctor-patient communications, and under our active guidance, Tingting finally regained her confidence in overcoming the disease.
Tingting manifested severe heart failure and cardiogenic shock in the early stage of the disease. After surviving the first hurdle, she began to receive regular anti-heart failure medication, while adjusting her lifestyle and psychological state. Slowly, her condition changed from severe to mild, and she was transferred from the heart failure care unit to the general ward, and finally discharged. Even after being discharged from the hospital at home, she needs to continue her recovery and have regular outpatient follow-up.
Once, Tingting didn't come to the outpatient clinic for several months, and I was a little worried about her. Finally, one day, she came, and I regretted to learn that less than half a year after she was discharged from the hospital, when her condition was getting better, her husband filed for divorce.
Fortunately, the ending is happy
It was a sudden major illness that made Tingting's husband lose confidence. Tingting was depressed for a few months before she came out of her misfortune again.
23%~78% of patients with perinatal cardiomyopathy can restore normal cardiac function. In general, the recovery of cardiac function begins one month after the onset of the disease, and the recovery is basically complete within 6 months. In a very small number of patients, the recovery period lasts for two years.
Tingting's heart function showed no signs of recovery half a year after the onset of the disease. I was particularly worried at the time, because based on probability and experience, there was a good chance that she would not be able to return to her normal state. However, a miracle happened when she became ill for a year, and she was completely cured! She started cycling and gradually increased the distance she took, and gradually felt that her body was back to its pre-onset state. It can be said that Tingting's ending is a happy one.
Now, Tingting, who is sitting in front of me, coaxes the child with a satisfied look. However, not every story has a happy ending. Looking at the lovely children, I thought of several perinatal cardiomyopathy patients before me.
The other is not perfect
A female patient from Shanxi, in her 20s, developed the disease less than a month after giving birth. In addition to the heart failure being particularly severe, she also had a large number of blood clots in her heart. She was treated locally and did not take any more anticoagulants after being discharged from the hospital. Later, her blood clot fell off with the beating of the heart, left the ventricles, and reached the brain and lower limbs with the blood flow, forming cerebral embolism and peripheral vascular embolism, which made her unconscious in an instant.
In the middle of the night, the roaring ambulance rushed her to the hospital, but she still failed to receive a cerebrovascular thrombectomy in time and never woke up again.
There is also a female patient from Hebei who got married and had children at the age of 30. Although she was treated with the best medications, her heart function barely recovered. Her whole body was swollen, and she was moving towards heart failure step by step. Later, she divorced, and for a while she was not even in the mood to see an outpatient clinic, and even stopped taking medicine on her own for several months, and did not have the financial ability to receive artificial heart implants or heart transplants. The year after her illness, she died of advanced heart failure.
The great power of love
May 12 is Mother's Day. Mother's love is speechless, deep as the sea. Patients with perinatal cardiomyopathy are mothers. They have paid a heavy price for the reproduction of the human race, and some women have even lost their lives as a result.
In ancient Greek mythology, Gaia was known as the god of the earth, the mother of the gods, representing the primordial force of nature that could create all life. Her appearance marks the beginning of the transformation of chaos from disorder to order, and also marks the beginning of the creation of all things.
And in reality, every mother is mortal. But the perseverance and unhurried spirit they showed, or the resilience to face illness and life calmly, are no less than Gaia. The warm winter sun shone into my consultation room, casting a soft glow over Tingting's silhouette, reflecting her and the baby like sacred statues. I felt a mysterious and warm power. It is this great power of love that helps patients to regain their lives and overcome human sickness and suffering. I believe that they will better understand the true meaning of life in their future lives, and the future of them and their children will be bright.
Source: Public Health magazine
Text: Zhuang Xiaofeng, Fuwai Hospital, Chinese Academy of Medical Sciences
Curator: Yu Yunxi
Editor: Luan Zhaolin Yang Zhenyu
Proofreader: Li Shiyao
Review: Qin Mingrui, Xu Bingnan