Presentation
Easy fatigability, cough, and dyspnea on mild exertion one week after childbirth. Heart rate: 96 bpm. History of pre-eclampsia. No prior history of heart failure.
Patient Data
Left ventricle:
dilated cavity: end-diastolic left ventricular diameter: ~6.8 cm with spontaneous echo contrast
no thrombus
normal left ventricular wall thickness.
impaired systolic function LVEF: ~35%, E point-septal separation (EPSS): 17 mm
no regional wall motion abnormalities
diastolic dysfunction (grade 2): pseudonormal relaxation pattern with elevated left ventricular end-diastolic pressures (LVEDP) average E/e': 16.8
Right ventricle:
normal in size with good systolic function
TAPSE: 2.5 cm
tissue Doppler imaging systolic velocity (TDI S'): 14.4 cm/s
Interventricular septum: intact
Atria:
left atrium: dilated, area: 22.8 cm2
right atrium: normal in size
Aortic valve:
normal tricuspid
moderate aortic regurgitation: pressure half time (PHT): 345 ms
mild holodiastolic flow reversal with an end-diastolic velocity of <20 cm/s in the descending aorta
Mitral valve:
severe mitral regurgitation with pulmonary vein flow reversal
regurgitant volume 220 mLs
regurgitant fraction: 69%, EROA: 1.22 cm2 (calculated using the stroke volume method, that is the difference between the inflow and outflow stroke volumes of the left ventricle)
Tricuspid valve:
-
mild tricuspid regurgitation
Additional findings:
mildly elevated pulmonary pressures (estimated sPAP ~43 mmHg)
dilated IVC with >50% inspirational collapse (not shown)
small pericardial effusion
Case Discussion
Postpartum cardiomyopathy is an idiopathic cardiomyopathy that presents with heart failure secondary to left ventricular systolic dysfunction toward the end of pregnancy or the first six months after delivery. The etiology remains unclear but some of the risk factors for the development of postpartum cardiomyopathy are multiple gestation, multiparity, older age, gestational hypertension, preeclampsia, or eclampsia. It can also be idiopathic without any risk factor.
Unable to process the form. Check for errors and try again.