A patient with peripartum cardiomyopathy was scheduled for elective caesarean section after stabilization on medical therapy. Wer performed a combined spinal epidural using one ml 0.5% hyperbaric bupivacaine (5 mg) with 0.3 mg diamorphine for the spinal. The epidural was topped up with 10 mL bupivacaine 0.5%. Significant haemodynamic changes consisted of reduction in heart rate and hypotension after the spinal, and tachycardia after delivery. The benefits and risks of this approach are discussed.
Pirlet, Baird, Pryn, Jones-Ritson, Kinsella, , , , (2000). Low dose combined spinal-epidural anaesthesia for caesarean section in a patient with peripartum cardiomyopathy. International journal of obstetric anesthesia, 2000 Jul;9(3):189-92. https://www.ncbi.nlm.nih.gov/pubmed/15321091