Postpartum cardiomyopathy is an important cause of heart failure in young women with an increasing rate in recent years. It may occur from the last month of pregnancy and up to five months after delivery. The etiology remains unclear and the disease has a high level of morbidity and mortality. Complications include CHF, arrhythmias, cardiogenic shock and thromboembolism. Treatment is similar to the treatment for CHF. Bromocriptine has shown encouraging preliminary results but is not standard therapy.
We present a 40 y/o healthy female that was referred to the ED due to shortness of breath. Upon admission she was stable respiratory and hemodynamically, she had tachycardia without fever. Her physical exam was normal except to rapid heart sounds, her abdomen had mild diffuse tenderness upon palpation and there was minimal edema on both ankles. ECG showed sinus tachycardia with an LBBB pattern. Chest X-ray and lab results were normal. Chest CT revealed a pulmonary embolism in the right lower lobe.
Echocardiogram revealed a mildly dilated left ventricle with mild to moderate systolic dysfunction. The left atrium was mildly dilated with higher pressure in the left atrium than right. Mitral valve leaflets were mildly thickened with moderate to severe regurgitation, tricuspid valve had mild regurgitation with moderately elevated pulmonary hypertension. BNP levels were high.
In this case we report a healthy postpartum woman that presented to our ED with a combination of a LBBB pattern on her ECG, PE on spiral CT and suspected PPCM on echocardiogram.