Case Series: Spontaneous Relapse After Recovery From Peripartum Cardiomyopathy

BACKGROUND: Peripartum cardiomyopathy (PPCM) is a distinct type of heart failure with reduced ejection fraction (EF) with variable outcomes. Rates of recovery range from 29% to 72% and mortality rates range from 0% to 25%. In studies, outcomes are often determined at 6 to 12 months following diagnosis, and many of those who recover stop following with cardiology and are lost to follow-up. CASE REPORT: Patient 1 was a 25-year-old G2P1 who was diagnosed with PPCM 5 days after childbirth with an EF of 25%. Initially, her EF improved and first normalized at 4.1 years after diagnosis. It subsequently dropped to 30% without clear heart failure symptoms or identifiable trigger and 1 year later normalized again to an EF of 60%. Patient 2 was a 36-year-old G6P3 who was diagnosed with PPCM 6 weeks after the birth of her third child when echocardiogram revealed an EF of 10%. Time to EF normalization was 3.0 years after diagnosis when her EF was measured at 55%. She remained without symptoms of heart failure for the first 8 years after diagnosis when she developed dyspnea on exertion and lower extremity edema; EF at that time declined to a nadir of 42.5% without apparent cause. CONCLUSIONS: Women with PPCM can have an unpredictable course, and those who appear to have recovered may have unrecognized subclinical dysfunction that places them at risk for future injury or deterioration.