EMSIG: Sudden Change of Heart: A Case of Peripartum Cardiomyopathy

Elise Collins*, Savannah Sadaiappen*, Ashley Green*, Meagan Josephs*, Marylynda Ogbudinkpa*, Napat Rangsipat*

* American University of the Caribbean School of Medicine

An 18 year-old African American female with no past medical history presented to the

Emergency Department after being found in ventricular fibrillation arrest at home by her mother. The patient was seven days postpartum, post-cesarean without complication. Per patient’s mother, she was pale and complaining of lower extremity edema this morning. Mother reports that she left patient alone briefly and upon return found her on the floor, unconscious, incontinent, episodically jerking, and foaming at the mouth. She was pulseless on EMS arrival, prompting three rounds of defibrillation and two doses of epinephrine. Upon ED arrival, she was tachycardic with a Glasgow Coma Score of 5. She was intubated and a femoral central line was established.

Her CTA showed a right pleural effusion and cardiomegaly along with an echocardiogram

revealing a dilated left ventricle and low cardiac output with an ejection fraction (EF) of 10-15%.

The patient’s initial presentation and postpartum status suggested a potential amniotic

fluid embolism or myocardial infarct. But with further studies a diagnosis of peripartum

cardiomyopathy (PPCM) was made. The patient was admitted to the MICU with a

cardiology/OBGYN consult and later discharged when a follow up examination revealed an

improved EF.

The etiology of PPCM is currently unknown, but PPCM affects as many as 1 in 1000

women in the United States. Young, African American females are especially susceptible and

have poorer outcomes ranging from cardiac transplant to death. About 75% of cases are

diagnosed within the first month postpartum and 45% present within the first week, such as the patient in this case. The prognosis is best when diagnosed and treated early, with most case recovering within 3-6 months of diagnosis. Thankfully, in this case the patient was diagnosed

and treated promptly, increasing her likelihood of recovery and decreasing her need for cardiac

transplantation.

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