Unexplained maternal tachycardia - is it peripartum cardiomyopathy?

NMUH Staff Publications

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<span style="font-size: 10pt;">Background Peripartum cardiomyopathy (PPCM) is a disorder of unknown cause. Left ventricular systolic dysfunction and symptoms of heart failure occur between the last month of pregnancy and the first 5 months postpartum. Incidence is estimated at 1:300 to 1:4000 pregnancies. Methods We report three cases of PPCM seen in our unit over the past year and literature review using PubMed and Medline. Results Case 1 A 32-year-old woman booked at 11 weeks' gestation in her first pregnancy. She had no significant past medical/social history. Her mother died of cardiomyopathy following her 6th pregnancy, but no familial investigations were undertaken. She was admitted with ruptured membranes at 39 weeks of gestation. She was persistently tachycardic, with hypertension and proteinuria. An echocardiogram revealed a non-dilated left ventricle with severely impaired systolic function and a LVEF of 18%. She was transferred to a tertiary unit for management of PPCM and delivery by caesarean section. Case 2 A 34-year-old woman booked at 12 weeks of gestation in her first pregnancy. She had no significant past medical, family or social history. She was admitted at 39 weeks of gestation with shortness of breath and hypertension. Two days after admission she had a placental abruption and a caesarean section with an EBL of 1200 mL. Postpartum she became tachycardic. An echocardiogram revealed a mildly dilated left ventricle with severely impaired systolic function and a LVEF of <25%. She was admitted to ITU and treated for PPCM. Case 3 A 31-year-old woman booked at 8 weeks of gestation in her third pregnancy. She previously had two normal deliveries. She had no significant past medical/social history. She had an uncomplicated caesarean section at 38 weeks of gestation for transverse lie. Postpartum she became tachycardic and hypoxic with chest pain. An echocardiogram revealed a mildly dilated left ventricle with severely impaired systolic function and a LVEF of <25%. She was transferred to a tertiary unit for further management of PPCM. Conclusion In all our cases the initial presentation varied, however common to all women was unexplained tachycardia which warranted investigation. An echocardiogram confirmed the diagnosis of PPCM. The pathogenesis of PPCM is poorly understood. Risk factors include: extremes of maternal age, high parity, African origin, pre-eclampsia, prolonged tocolysis and twin pregnancy. The most common presentation is with the symptoms and signs of systolic heart failure. Mortality rates as high as 42% have been reported and early diagnosis is vital to ensure prompt treatment. (Conference abstract)</span>