By: Dr. Farhala Baloch, Dr. Zainab Samad and Varisha Madni
As Fatima* entered the final trimester of her pregnancy, she noticed her legs and feet swelling and felt breathless even with minimal exertion. She wondered, “Is this normal in the last few months of pregnancy?” As her delivery date approached, her symptoms worsened. One day, she got so sick her husband her husband had to rush to the hospital, where she was diagnosed with Peripartum Cardiomyopathy.
Peripartum Cardiomyopathy or PPCM is a rare condition that weakens the heart muscle and can lead to heart failure. It typically arises in the late stages of pregnancy or shortly after delivery, without any prior history of heart disease. Cardiomyopathy refers to a disease of the heart muscle, where the muscle weakens, reducing the amount of blood pumped with each heartbeat. PPCM is rare in the United States, Canada, and Europe, occurring in 1 out of every 1,000 to 1 in 4,000 pregnancies. While the incidence of PPCM seems to be increasing in these regions, it may be more common in countries like Haiti, Nigeria, and South Africa. However, due to a lack of comprehensive data, the exact prevalence of PPCM in Pakistan remains unclear. Single-center observational studies suggest that women over 25, with a mean age of 30 years, are more likely to develop PPCM in Pakistan.
The symptoms of PPCM can often mirror those experienced in the last trimester of pregnancy, such as shortness of breath with physical activity or while lying down, and swelling in the ankles and feet, making the condition difficult to diagnose. Other signs of PPCM include chest pain or tightness, coughing, heart palpitations, fatigue, and, less commonly, light-headedness.
For Fatima, urgent delivery of her baby became the immediate solution to save both her life and her child’s. PPCM can lead to prolonged hospitalization for both mother and baby. Therefore, timely diagnosis and management by a team of specialists are crucial for ensuring the best outcomes for both.
A diagnosis of PPCM is made if the mother develops heart failure symptoms within the last month of pregnancy or up to six months post-delivery, shows reduced heart function on echocardiography, and no other causes of heart failure are found. A genetic predisposition, such as a family history of cardiomyopathy, is a significant risk factor. However, in many cases, PPCM is idiopathic, meaning the exact cause is unknown.
Treatment of PPCM generally follows standard heart failure guidelines. However, if the patient is still pregnant, treatment can be complicated, as certain heart failure medications are either contraindicated or have not been adequately tested in pregnancy. It is essential for expectant mothers with heart disease to be under the care of an experienced specialist.
Although PPCM is rare, it can have a profound impact on motherhood. Expectant mothers should remain vigilant, and any unusual or suspicious symptoms should prompt immediate medical evaluation.
Dr. Farhala Baloch, Cardiologist, The Aga Khan University Hospital
Dr. Zainab Samad, Cardiologist and Chair, Department of Medicine, The Aga Khan University Hospital
Varisha Madni, Medical Student, The Aga Khan University
*Name changed for anonymity.
Disclosure: Dr. Farhala Baloch is Fogarty Fellow, and her work is supported by the Fogarty International Center of the National Institutes of Health under Award Number D43TW011625.
