Case Discussion - Cardiac Failure Developing On 3rd day Postpartum

A 27 year old female para 2 (h/o of both LSCSs), on the 3rd postoperative day of caesarean develops sudden cardiac failure.
– She has weakness, shortness of breath, palpitation, nocturnal dyspnea and cough.
– O/E- Tachycardia, arrhythmia, peripheral edema, pulmonary rales are present. S3 is present but no murmur is heard.
– She had been a booked patient with regular antenatal checkups and with no prior heart problem and uneventful prior obstetric history.

What is the probable diagnosis?

Case Discussion:
The diagnosis of peripartum cardiomyopathy should be kept in mind in all such cases.

The criteria for diagnosis are:
1. Cardiac failure within last month of pregnancy or within 5 month postpartum.
2. No determinable cause for failure (may be immunological or nutritional).
3. No previous heart disease.
4. Left ventricular dysfunction (Echocardiography) as evidenced by ejection fraction < 45%
5. Left ventricular end-diastolic dimension > 2.7 cm/m2.


Predisposing Factors:
• Multiparous
• Young 20-35 years
• Twins pregnancy
• Chronic hypertension pre-eclampsia
• Prolonged tocolytic therapy.

Investigation:
• Chest X-ray: Enlarged heart and pulmonary vascular redistribution.
• Echo: Enlargement of all chambers of the heart (predominantly left heart) with decreased ejection fraction in left ventricle.