Spontaneous Peripartum Cardiomyopathy Relapse

Abstract

Peripartum cardiomyopathy (PPCM) is heart failure occurring without any determinable heart disease during the last month of pregnancy or the first six months postpartum. PPCM may be underappreciated, as many patients stop follow-up as soon as they achieve a normal EF. We contribute with an unusual case of short-lived cardiomyopathy in a 36-year-old female, while in this hospitalization was experiencing stressful circumstances, in the absence of pregnancy and other apparent causes of cardiomyopathy, yet to recover two days later. We believe with a history of PPCM in a prior pregnancy; this could be a PPCM relapse after excluding viral and connective tissue etiology. It is unclear when a patient with PPCM may be considered fully recovered and heart failure medications safely discontinued. Restoration of ejection fraction (EF) may not represent complete recovery. The lessons learned here are that there are no PPCM guidelines, limited conflicting data exist regarding the long-term management of PPCM patients with recovered LV function, and relapse of PPCM may be misdiagnosed with Takotsubo  syndrome.