Post-partum heart disease.

Post-partum heart disease has been described by several authors (Gouley et al. as a well-defined condition, exhibiting a uniform clinical picture, due to several possible etiological factors, many of which are often difficult to recognize. Notwithstanding these studies, the problem of heart failure occurring in the puerperal period in the absence of pre-existent cardiac disease is still far from being clear. The initial signs of decompensation usually appear during the last weeks of pregnancy and are often so slight as to be misinterpreted; they decrease immediately after delivery, often to reappear subsequently in a much more severe degree. It is our opinion, based upon a series of 18 cases, most of which were followed throughout their entire clinical course, that this condition is not a specific or characteristic clinical syndrome, but is rather the result of multiple factors leading to cardiac failure. The presence of certain characteristics have enabled us to classify these cases into several groups. Although the first cases of myocardial degeneration occurring during pregnancy and the puer-perium were described in the last century (Porak, 1880; Virchow, 1870), and although a number were published in the earlier part of this century, emphasizing the importance of cardiac disease occurring in late pregnancy or in the puerperium (Blacker, 1907; Campbell, 1923), it was the work of Hull and his associates (1937, 1938) that suggested the existence of a well defined clinical entity and described its diagnostic features. These authors emphasized the favourable prognosis and the frequent occurrence of arterial hypertension, possibly related to a previous pregnancy or puerperium; they also found that embolism was common: two aetiological factors mentioned were, pregnancy toxemia and puerperal glomerulo-nephritis, both of which may cause a rapid elevation of the blood pressure. Another important contribution to this subject, published almost simultaneously, was the interesting paper by Gouley et al. (1937) describing 7 instances of advanced puerperal heart failure, with 4 deaths, mostly due to embolism from mural thrombi. The myocardial lesions differed considerably from the usual pathological findings in heart failure, showing great variation of distribution throughout the cardiac tissues. These authors thought that several factors were involved in such cases, and although the puerperal factors were mainly responsible, they emphasized the importance of pre-existing cardiac damage. Subsequently, a number of papers were published concerning the cardiac complications of pregnancy toxamia (Benchimol et al. pointing out the clinical and pathological significance of these findings. Some …