Case Report of Postpartum Cardiomyopathy: Rare and Complex in Nature

About 4% of pregnancies occurring in western industrialized countries are affected by cardiovascular disease. Of that percentage of the pregnant population, 1 in 2289 to 4000 within the United States will develop into postpartum cardiomyopathy (PPCM). This cardiovascular disease is defined as a non-familial form of idiopathic cardiomyopathy occurring between the last month of pregnancy to five months postpartum. Currently there are 3 diagnostic criteria: timing of incidence, absence of heart failure (HF) etiology, and absence of prior heart disease. Recent evidence suggests that ECG findings of left ventricular dysfunction can also be inclusive for diagnosis. PPCM shares symptoms similar to other cardiovascular etiologies that can present acutely or slowly over time. This makes distinguishing the disease increasingly difficult for health care providers. A 35-year-old Hawaiian female was admitted for robotic mitral and tricuspid valve repair due to severe regurgitation. She was 2 months postpartum at admission and had a past medical history for pulmonary edema, thyroid nodule, pre-eclampsia, gestational diabetes, and PPCM. During surgery, she was discovered to have a patent foramen ovale requiring closure. Post operatively, she developed multiple small infarcts, respiratory failure, acute nephritis, fever with negative cultures, thrombocytopenia, DIC, and multiple troponin level spikes. She was admitted to the CICU and required multiple critical procedures to stabilize her diminishing state. As the case will suggest, a patient\u27s presentation with PPCM is complex and contains a higher number of variables then a standard HF patient. Early recognition and management is critical in a disease that has a mortality rate of 28%, even with appropriate therapy. Survivors typically require chronic HF management and often transplantation. More research is still required to further understand the etiology, methods for earlier detection, and further mortality reduction in PPCM