Peripartum Cardiomyopathy

C. E. Sebayang1, R. A. Tarigan2, T. S. Sitepu3, 1Faculty of Medicine, Universitas Kristen

Indonesia, Jakarta, Indonesia; 2Efarina Etaham Hospital, Berastagi, Indonesia; 3Faculty of

Medicine, Universitas Sumatera Utara, Medan, Indonesia

Background: Peripartum cardiomyopathy (PPCM) is a life-threatening condition associated

with left ventricular (LV) dysfunction occurring during the last months of pregnancy or in the

months following delivery in previously healthy women. Outcomes vary, because most

women experience complete LV recovery, but a significant minority experience persistent

cardiac dysfunction, transplant, or death.

Case: A 26-year-old woman was consulted to cardiologist 12 hours after giving birth,

reporting dyspnea on exertion, fatigue, orthopnea, and paroxysmal nocturnal exertion. There

is a history of gestational hypertension on current pregnancy. Physical examination shows a

regular heart rhythm accompanied by ronchi sound in the basal aspect of the lung. An

electrocardiogram showed sinus rhythm with T-inversion in V1-V3. An echocardiogram

showed an LV ejection fraction of 33,74%, LV internal diameter end systole of 4,61 cm, and

tricuspid annular plane systolic excursion of 12 mm. The patient was given furosemide,

spironolactone, candesartan, amlodipine, and ceftriaxone. The patient was discharged from

the hospital 5 days later and instructed to take furosemide, amlodipine, nitroglycerin,

spironolactone, and bisoprolol.

Discussion: The cause of PPCM remains unknown and there is no diagnostic test specific to

PPCM. Women generally present with symptoms that are common to pregnancy (orthopnea,

dyspnea on exertion, fatigue, edema, paroxysmal nocturnal exertion, and chest tightness), so

the diagnosis of PPCM may be delayed or missed altogether. Women diagnosed with PPCM

should be treated with guideline-directed medical therapy for heart failure with reduced
ejection fraction, bearing in mind the safety of medications during pregnancy and

breastfeeding.

Keywords: peripartum cardiomyopathy, heart-failure, pregnancy