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Abstract

Background: Peripartum cardiomyopathy (PPCM) is a life-threatening cardiomyopathy characterized by acute or slow progression of left ventricular (LV) systolic dysfunction (LV ejection fraction of <45%) late in pregnancy, during delivery, or in the first postpartum months, in women with no other identifiable causes of heart failure. This condition may mimic the clinical presentation of a respiratory infection, making accurate diagnosis challenging for physicians and potentially leading to treatment delays that pose significant risks to pregnant women. 

Case Illustration: A 21-year-old female was admitted with dyspnea perceived in the last 2 days before admission. In her past clinical history, the patient complained of cough and shortness of breath and was diagnosed with respiratory infection one week prior which initially improved; however, the symptoms recurred and progressively worsened over the preceding two days. Currently, the patient is primigravida at 39 weeks of gestation. Twelve-lead electrocardiography revealed sinus tachycardia at a heart rate of 135 bpm. The echocardiography showed left ventricular dilatation with moderate mitral regurgitation (MR) and reduced ejection fraction (20%). Furosemide, nifedipine, and digoxin were administered. The patient was also consulted by an obstetrician and a gynecologist, and termination of pregnancy was advised. After termination of pregnancy, the patient's condition stabilized and the patient was discharged after being monitored in the ICU for 3 days with maintenance of lisinopril and bisoprolol. At seven-month follow-up, echocardiography showed recovered left ventricular systolic function (LVEF 55%) without mitral or tricuspid regurgitation.

Conclusion: This case highlights the reversible nature of PPCM, even when presenting with acute pulmonary edema in late pregnancy. Early recognition, pregnancy termination when indicated, and guideline-directed medical therapy alone may result in complete recovery of left ventricular function. 

Keywords

Peripartum cardiomyopathy; Heart failure; Primigravida; Pregnancy heart disease     

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