Peripartum Cardiomyopathy (PPCM): Dual Case Report and Review of Literatures

Abstract

Abbreviation: LV, left ventricular; LVEF, left ventricular ejection fraction; BNP, brain natriuretic peptide; EF, ejection fraction; PND, paroxysmal nocturnal dyspnea; BiPAP, bilevel positive airway pressure; LTCS, low transverse cesarean section; ARBs, angiotensin-receptor blockers Introduction and background Peripartum cardiomyopathy (PPCM) is a form of dilated cardiomyopathy of unclear etiology, defined as heart failure secondary to left ventricular (LV) systolic dysfunction, 1 which affects women without preexisting heart disease during the last month of pregnancy or during the first 5 months of postpartum. 1-3 Patients with PPCM often show a severely reduced left ventricular ejection fraction (LVEF) at the time of diagnosis, but may recover a relevant proportion of their cardiac output. 4 The incidence has been fully agreed upon but it estimated to be 0.025% to 0.03%, i.e. (1/4000) to (1/3000) births respectively. 5 Although PPCM shows a marked geographic and ethnic variation, it is most common in Africa and therefore among women of African descent. 4-6 Most women present in the first month postpartum with typical heart failure symptoms such as dyspnea, lower extremity edema, and fatigue. 3,4,7 PPCM can be particularly dangerous, as symptoms can be erroneously diagnosed as part of the normal puerperal process. 8