Clinical Profile of Patients with Peripartum Cardiomyopathy: A Single-center Experience and Review of Literature

Aim and background: Peripartum cardiomyopathy (PPCM) refers to a heart failure secondary to systolic dysfunction with left ventricular ejection fraction <45%, with no known prior cardiac disease.The clinical features of PPCM overlaps with physiological symptoms of pregnancy, leading to its delayed diagnosis and increased morbidity and mortality.The aim of this case series and review of literature is to increase the awareness of general care physician and obstetricians to this rare clinical entity.Case description: This is a case series of 5 patients with PPCM.All the patients were young (aged 22-30 years).All five of them presented in their third trimester with features of congestive heart failure.The most common high-risk factor among all patients was hypertension.Bedside echocardiography revealed LV dilatation with left ventricle ejection fraction (LVEF) <45% suggestive of PPCM.Patients were managed by multidisciplinary team and active management of heart failure was done.Two out of five patients were delivered vaginally, while the rest three underwent cesarean section for different indications.One of the two patients delivered vaginally underwent cardiac arrest 2 hours post-delivery and could not be resuscitated.Four out of 5 patients survived.Three of them were discharged home with no other sequelae and recovered their left ventricular functions at variable time periods after delivery.One of these four patients had the longest duration of hospital stay of 3 months.She suffered two episodes of cardiac arrest post-delivery.Patient suffered the cerebrovascular injury and developed paraplegia.Physiotherapy and rehabilitation were started along with the heart failure medications and were discharged home on the same.Her left ventricular functions did not recovered even at 12 months follow-up.Conclusion: Association of preeclampsia in this condition warrants future research to ascertain if recovery of ventricular function and hence the recovery of patient is different when PPCM is not associated with preeclampsia and if the management also differs in both the scenarios.Clinical significance: Echocardiography remains the gold standard in diagnosing the condition and must be incorporated in the initial workup of patients presenting with features of heart failure in late third trimester and early postpartum period.