A 35 year old African American woman who gave birth to twins 2 months ago presents with marked dyspnea and cough, sometimes bringing up blood. She says that she requires several pillows to sleep and will wake up short of breath several times in the night. Although she had pre-eclampsia in pregnancy, her cardiac function before that was normal. There was postpartum hypertension.
You do a cardiac work-up and find LV ejection fraction of 35%; EKG with sinus tachycardia, nonspecific ST wave abnormalities, and voltage abnormalities; echo showing global reduction in contractility and LV enlargement; and CXR confirming enlargement of the cardiac silhouette with pulmonary venous congestion. You rule out PE, amniotic fluid embolus, anxiety, infection, and asthma.
Challenge: What's the diagnosis here?
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First Described in 1849
This is peripartum cardiomyopathy (pregnancy-associated cardiomyopathy), an idiopathic rare cause of heart failure in women late in pregnancy or early puerperium. Treatment is similar to that for systolic dysfunction heart failure.
Source: UpToDate.
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