Revisiting Peripartum Cardiomyopathy: A Subsequent Pregnancy

Peripartum cardiomyopathy, or pregnancy-associated cardiomyopathy, is the development of left ventricular dysfunction usually occurring during the last trimester of pregnancy, shortly after delivery, or five months postpartum. As a result of the cardiovascular strain of pregnancy, patients who have developed peripartum cardiomyopathy, particularly those with persistent left ventricular dysfunction, are strongly advised against subsequent pregnancies. If a subsequent pregnancy should occur in the setting of a diminished left ventricular ejection fraction, the risk of fetal and maternal morbidity and mortality increases significantly. This case describes a 25-year-old Caucasian female patient who became pregnant eighteen months after developing peripartum cardiomyopathy. The association between barriers to adequate care and increased development of peripartum cardiomyopathy in both a rural and global setting has been recognized by several researchers. Literature has shown that expectant mothers from underserved areas, those of African descent and those who smoke, have hypertension, or use cocaine carry a greater risk of developing peripartum cardiomyopathy. Therefore, in addition to the related complications of peripartum cardiomyopathy, practitioners in underserved areas with high-risk populations should be aware of the risk factors and pathophysiologic manifestations inherent with the disease.