Response to Adam Morton's Letter 'Reply to: Timothy A C Snow, Cara A Wasywich and Fiona M Stewart. A case of breathlessness during pregnancy: the difficulty in diagnosing heart failure'

摘要

Our thanks to Dr Morton for his thought provoking letter.He asks whether the clomipramine may have contributed to her dilated cardiomyopathy. Our patient had been on clomipramine for several years prior to her admission. If she had prior left ventricular impairment from clomipramine we would have expected her cardiac function to have decompen-sated earlier in pregnancy (around 20-28 weeks' gestation, corresponding to the time of maximal rate of increase in cardiac output). She presented at 31 weeks' gestation with at most a two-week history of deteriorating shortness of breath. This patient was re-challenged with clomipramine a year ago due to escalating obsessive compulsive disorder. Over that time we have seen continued improvement of her left ventricular function.