# Epidural Anesthesia for Cesarean Section in a Patient With Severe Dilated Cardiomyopathy: A Case Report

## TL;DR

Epidural anesthesia was safely used for a cesarean section in a patient with severe heart disease, avoiding major risks.

## Contribution

Demonstrates the safe use of epidural anesthesia in severe dilated cardiomyopathy during cesarean section.

## Key findings

- Epidural anesthesia maintained hemodynamic stability in a patient with severe DCM during cesarean section.
- Incremental dosing and monitoring helped avoid sudden cardiovascular changes.
- Multidisciplinary planning was essential for successful outcome.

## Abstract

Dilated cardiomyopathy (DCM) in pregnancy presents a significant anesthetic challenge due to compromised myocardial function and limited cardiac reserve. Selection of the anesthetic technique is critical to minimize hemodynamic fluctuations. A 35-year-old gravida 5 para 2+2 at 31 weeks’ gestation with severe intrauterine growth restriction (IUGR) and known dilated cardiomyopathy (ejection fraction 20-25%) underwent elective cesarean section and tubal ligation under epidural anesthesia. Careful titration of local anesthetic, invasive blood pressure monitoring, and multidisciplinary planning ensured hemodynamic stability throughout the procedure.

Epidural anesthesia allows incremental dosing and gradual sympathetic blockade, maintaining preload and afterload within tolerable limits in patients with poor ventricular function. This approach is associated with fewer sudden cardiovascular changes compared to spinal or general anesthesia. Epidural anesthesia can be safely and effectively used for elective cesarean section in non-laboring patients with severe DCM, provided meticulous monitoring and collaborative perioperative management are ensured.