This chest radiograph reveals diffuse bilateral pulmonary edema. The probable diagnosis of peripartum cardiomyopathy (PPCM) should be considered and a transthoracic echocardiogram should be obtained. The patient was treated with intravenous furosemide with significant improvement. As PPCM is a diagnosis of exclusion this patient also had a Chest CTA which was negative for pulmonary emboli. A echocardiogram revealed an LV ejection fraction of 25% to 30%, with trace aortic and mitral regurgitation. The patient was admitted and Cardiology consulted. The patient was treated with appropriate medications for heart failure. A follow-up echocardiogram three months later showed normalization of her ejection fraction to 60%.
PPCM, as defined by the Heart Failure Association of the European Society of Cardiology Working Group on PPCM 2010, is an idiopathic cardiomyopathy that presents with heart failure secondary to left ventricular systolic dysfunction toward the end of pregnancy or in the months after delivery, in the absence of any other cause of heart failure. PPCM is a diagnosis of exclusion. Although the left ventricle may not be dilated, the ejection fraction is nearly always reduced below 45%.
PPCM risk factors include: high parity, high gravidity, mutifetal gestation, prolonged tocolysis, smoking, extremes of reproductive age, malnutrition, genetics and ethnic/socioeconomic factors.
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1. Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail. Aug 2010;12(8):767-78.