Peripartum Cardiomyopathy: The Camouflage of Symptoms in Pregnancy

Abstract

Aim: This case report aims at increasing the awareness about peripartum cardiomyopathy (PPCM) in antenatal mothers and the need for a multidisciplinary approach, including a team of cardiologists, anesthesiologists, and neonatologists along with the obstetrician toward planning the management of this condition. Background: The most common causes of cardiomyopathy in a woman of childbearing age are viral infection, drug-induced cardiomyopathy, and PPCM. Peripartum cardiomyopathy is a rare incidence with unclear etiology in obstetric practice. The usual presenting symptoms are features of congestive cardiac failure, but some uncommon presentations like unstable arrhythmias and arterial thromboembolism are also present. Increased recognition of PPCM as a disease entity and advanced perinatal care have resulted in improved prognosis with a mortality rate of 0.5–16.5%. Case description: We present a case of PPCM in a 21-year-old Gravida 3, Para 2, with no live children at 36 weeks and 3 days of gestation with a past history of vaginal deliveries with early neonatal death following the first pregnancy and a stillbirth in her second pregnancy. She was referred to our hospital with chief complaints of breathlessness on exertion and swelling of the legs for a period of 3 days and abdominal pain on and off. She was diagnosed with a case of PPCM and was successfully managed in our tertiary care hospital with a team of obstetricians, cardiologists, neonatologists, and anesthetists. Conclusion: Peripartum cardiomyopathy is a rare obstetric complication that often presents with normal pregnancy symptoms which are exaggerated. A screening echocardiogram, especially in the third trimester of pregnancy, when there is even a slight increase in symptoms suggestive of heart failure, is important for prompt diagnosis and management. Peripartum cardiomyopathy also needs high vigilance and follow-up visits with a cardiologist after delivery. Clinical significance: Peripartum cardiomyopathy is reported to be associated with life-threatening complications like heart failure, cardiogenic shock, arrhythmia, and thromboembolism that can occur in PPCM.