Diagnostic Pitfalls in Peripartum Cardiomyopathy: Insights from a Tertiary Referral Centre

Peripartum cardiomyopathy is a rare, potentially fatal, and easily overlooked cause of heart failure in the peripartum period, because its presenting symptoms mimic pneumonia, pulmonary embolism, anaemia, or the normal physiological burden of pregnancy. To describe the diagnostic challenges encountered in three consecutive women with definite or probable peripartum cardiomyopathy at a tertiary referral centre and to draw out practical lessons for earlier recognition in routine clinical practice. We retrospectively reviewed three consecutive women evaluated for definite or probable peripartum cardiomyopathy at a single tertiary internal medicine department, characterising presentation, diagnostic work-up, treatment, and follow-up from hospital records. All three women had at least one established or previously reported factor associated with PPCM, including preeclampsia, multiparity, twin pregnancy, or anaemia; all were also active smokers. All three initially presented with, or were being treated for, conditions that either mimicked or coexisted with PPCM (suspected pulmonary embolism, community-acquired pneumonia, or severe iron-deficiency anaemia) before echocardiography demonstrated left ventricular systolic dysfunction with an LVEF of 25–35%. Patient 1 achieved normalisation of LVEF within one month, whereas Patient 2 had persistent LV systolic dysfunction. Patient 3, classified as having probable PPCM in the presence of a previously unrecognised atrial septal defect, showed partial recovery to 45–48% by three months. Peripartum cardiomyopathy should remain an active differential in any peripartum woman with unexplained dyspnoea, even when an alternative diagnosis appears to explain the presentation. Early natriuretic peptide testing and echocardiography, cautious application of diagnostic criteria in the presence of confounding comorbidity, and attention to treatment adherence and follow-up are important for timely recognition and long-term management.