Respiratory-onset peripartum cardiomyopathy across 49 studies was commonly misattributed to asthma, pneumonia, or pulmonary embolism, frequently resulting in diagnostic delay.
Systematic Review (n=49)
What are the diagnostic pitfalls and clinical outcomes associated with respiratory-onset peripartum cardiomyopathy?
Respiratory-onset peripartum cardiomyopathy is frequently misdiagnosed as primary pulmonary disease, highlighting the critical need for early echocardiography and natriuretic peptide testing to prevent severe clinical deterioration.
Abstract Introduction Peripartum cardiomyopathy (PPCM) may initially present with prominent respiratory symptoms that resemble primary pulmonary disease, particularly in late pregnancy and the early postpartum period. In clinical practice, this presentation often triggers alternative diagnostic pathways, introducing delay at a time when rapid cardiac assessment is critical. Although respiratory-dominant presentations are repeatedly described across case-based and observational reports, they have not been systematically examined as a distinct diagnostic pathway within the PPCM literature. Content This PRISMA-guided systematic review synthesized evidence relating to respiratory-onset presentations of PPCM. Major databases and registers were searched comprehensively. Following screening of 589 records and full-text assessment of 145 reports, 49 studies met inclusion criteria. Twenty studies were qualitatively prioritized for narrative synthesis using ROBIS-informed methodological appraisal. Evidence was examined across diagnostic misclassification patterns, cardiopulmonary mechanisms, differential diagnoses, investigative strategies, and acute and longitudinal management considerations. Summary Respiratory-led presentations were commonly misattributed to asthma, pneumonia, pulmonary embolism, or perioperative causes, with diagnostic delay frequently reported. Across heterogeneous study designs, cardiogenic pulmonary edema with left-ventricular systolic dysfunction emerged as a recurring unifying mechanism. Early use of echocardiography, natriuretic peptides, and targeted imaging consistently aided differentiation from primary respiratory pathology. Severe clinical deterioration was often described in the context of delayed recognition. Outlook Respiratory-onset PPCM represents a high-risk diagnostic pathway rather than a discrete disease entity. Prospective registries, standardized diagnostic algorithms, and closer integration of obstetric and cardiopulmonary care are needed to refine early recognition and improve maternal outcomes.
Andonotopo et al. (Mon,) conducted a systematic review in Peripartum cardiomyopathy (n=49). Respiratory-onset presentation was evaluated on Diagnostic misclassification patterns, cardiopulmonary mechanisms, differential diagnoses, investigative strategies, and management considerations. Respiratory-onset peripartum cardiomyopathy across 49 studies was commonly misattributed to asthma, pneumonia, or pulmonary embolism, frequently resulting in diagnostic delay.