Case Series: Spontaneous Relapse After Recovery From Peripartum Cardiomyopathy

Background Peripartum cardiomyopathy (PPCM) is a distinct type of heart failure with reduced ejection fraction (EF) with variable outcomes. Rates of recovery range from 29% to 72% and mortality rates range from 0% to 25%. In studies, outcomes are often determined at 6 to 12 months following diagnosis, and many of those who recover stop following with cardiology and are lost to follow-up. Case report Patient 1 was a 25-year-old G2P1 who was diagnosed with PPCM 5 days after childbirth with an EF of 25%. Initially, her EF improved and first normalized at 4.1 years after diagnosis. It subsequently dropped to 30% without clear heart failure symptoms or identifiable trigger and 1 year later normalized again to an EF of 60%. Patient 2 was a 36-year-old G6P3 who was diagnosed with PPCM 6 weeks after the birth of her third child when echocardiogram revealed an EF of 10%. Time to EF normalization was 3.0 years after diagnosis when her EF was measured at 55%. She remained without symptoms of heart failure for the first 8 years after diagnosis when she developed dyspnea on exertion and lower extremity edema; EF at that time declined to a nadir of 42.5% without apparent cause. Conclusions Women with PPCM can have an unpredictable course, and those who appear to have recovered may have unrecognized subclinical dysfunction that places them at risk for future injury or deterioration.