Introduction: Peripartum Cardiomyopathy (PPCM) is a rare disorder, defined as the onset of acute heart failure, without demonstrable cause, in the last trimester of pregnancy, or within the first 6 months after delivery. It is often unrecognized, as symptoms of normal pregnancy mimic those of mild heart failure. PPCM is seldom presented as a cardiac arrest.
Objectives: The purpose of our presentation is to raise awareness and suspicion of PPCM, even when symptoms are mild, and to suggest a clinical evaluation of pregnant women, before lethal or disabling events occur.
Methods and Results: A healthy 42-yr-old woman with well documented ventricular fibrillation, was admitted to CCU after cardiac arrest and resuscitation at home, 10 days after her 5th child was born. On arrival the patient was unconscious. On examination S3 was detected. An ECG revealed sinus tachycardia of 110bpm, while an echocardiogram demonstrated global reduced left ventricular function. Brain CT and Coronary arteriography were normal. There was no evidence of pulmonary embolism on CT angiography. Serum markers of acute coronary syndrome were negative. Therapy included artificial respiration and hypothermia. The patient recovered after one week, and an automatic cardiac defibrillator (AICD) was implanted before discharge.
This patient resembles another young 28-yr-old woman, who was admitted to CCU eight years ago, in her 38-week 3rd pregnancy, because of palpitations and dyspnea; on examination S3 was detected, with documented non-sustained Ventricular Tachycardia (VT), with LBBB pattern and right axis of QRS, that was successfully treated with Carvedilol and Quinidine (following obstetric consultation). An echocardiogram revealed moderate global reduced left ventricular function.
In summary, 2 female patients, out of 12 patients with PPCM (16%), between the years 2000-2011, with the mean age of 34 years (range 24-42) have been diagnosed as suffering of PPCM, that presented with ventricular arrhythmias (one in a malignant form).
Conclusions: Our conclusions: PPCM is a rare disease, that, when appears, may have a lethal or disabling presentation. Careful follow-up should be performed for every pregnant woman, especially in the presence of symptoms, however mild. The question of expanding perinatal care, to meticulous clinical, and electrocardiographic evaluation, should be considered.