could this have been PPCM

[beck94]

I am concerned that I may have had PPCM following my second pregnancy and wondering what your opinion is with my symptoms. I will give a little history. Five years ago my daughter was born at 36 weeks due to severe preeclampsia. I was induced as soon as my blood pressure was up. It ranged from 140s to 160s over 90s to 110s. Everything went fine during the delivery. I was placed on Aldomet following her delivery. When I arrived home, I began to feel extremely tired (feeling as though I would fall asleep at any moment) and more swelling in my feet and ankles (I was already swollen due to the pregnancy). I also felt as though my heart was enlarged (this might sound crazy, but it did) and I also had a very slow heart rate (40s to 50s). I also remember one episode of coughing (dry cough). My blood pressure remained elevated with at least one time reaching 190/120. Also, I do not recall feeling short of breath postpartum, although I was during the pregnancy, which I assumed was normal due to the pregnancy. I do not recall these symptoms lasting very long, maybe 2 weeks at max. Eventually, everything returned normal and I was weaned off the Aldomet when my pressures began to reach normal levels (apprx 1 to 2 months postpartum).

Two years ago, (3 years after delivery) while at an annual checkup, my doctor noticed a 1/6 murmur and sent me for an echocardiogram. This was basically normal with an EF of 65% and with trace mitral and tricuspid regurgitation. Everything else was normal.

I want to have another child, but am afraid that this might have been PPCM. I have mentioned this to my OB doctor and he looked over my echocardiogram and listened to my heart and heard no murmur. He told me that my symptoms were common with use of Aldomet and not to worry. I still do though.

My questions then are: Are these symptoms consistent wtih Aldomet use? Is there anyway to know if I did have PPCM without having an echo back then?

Thank you very much for your insight into this. I am very nervous about attempting another pregnancy with this thought in my mind.

[JAMESFETT]

Thank you for sharing your story. There is nothing confirmative of PPCM in that medical history and findings. I assume that your diagnosis of preeclampsia was correct. I wonder if you had protein in the urine at that time? (as would be seen with toxemia or pre-eclampsia). If you did not have preeclampsia, you certainly had hypertension of pregnancy. Your B.P. is now normal, and you are on no BP meds. With Aldomet you could have had some associated edema from sodium retention. I assume your echo did not show any evidence of ventricular septal or posterior wall thickness, thus no evidence of chronic hypertension; and of course your BP is normal now. When you had a pulse of 40 to 50 did you have an electrocardiogram done? Sometimes a cardiomyopathy can be associated with a heart block rhythm, but that would require an electrocardiogram to diagnosis. On the other hand a young healthy person may have a normal slow pulse. In a perfect world you would have had an echocardiogram done with the symptoms after the birth of your daughter, but I must say there were not really strong indications for doing one, so I'm not being critical of anyone about it. Anyway, we don't know what your EF would have been then, nor in the next three years. It is of course hugely reassuring to have had an EF of 65 % 2 years ago. Thus, I would conclude you probably never did have PPCM, that you did have preeclampsia, and that your risk of developing heart failure PPCM with a subsequent pregnancy is very low. I hope that helps a bit.

JD

[JAMESFETT]

P.S. A grade 1/6 systolic murmur is very common in normal people, sometimes occurring with the presence of anemia or low hemoglobin. Your echo showed slight mitral and tricuspid regurgitation, which again, is quite common, and not alarming. I assume the anatomy of the valves was otherwise normal. From your echo, what was the size of your left ventricle? If you have the report, I am interested in knowing the end-diastolic dimension (EDD), and the end-systolic dimension (ESD). those would be in centimeters. Also your height and weight. From those I can calculate the Fractional Shortening (FS), which I asssume will be normal, certainly above 30percent, judging from your EF.

JD

[JAMESFETT]

PPS: The Aldomet would certainly be able to cause fatigue or tiredness, as a common side-effect.

JD

[beck94]

Thanks. That is very reassuring to me. I was totally unaware of this condition back then and only in the last few years have I heard of this through my work (medical transcriptionist). I have been worried about those symptoms for quite some time! Since I was unaware of PPCM then, I did not bring any of this to the attention of my doctor and just assumed it was normal, that my body was just trying to get back to normal; therefore, an echocardiogram was not performed.

I had my echo done at another facility than my OB hospital and I turned the results in to him during my prepregnancy consult. I do remember that my size and thickness was normal. I do not know what the EDD and ESD was. I am 31 now (29 at the time of my echo). I am 5 feet 5 inches weighing 128 pounds.

Also, I was diagnosed wtih preeclampsia in both my pregnancies (both induced at 36 weeks) with trace protein and swelling in hands, feet, and face. Other than that, I had no other symptoms of preeclampsia, so am not sure if it was true preeclampsia.

If I get ahold of my echo results again, I will definitely give you them.

Thanks so much. You have lifted a huge weight off me!!

[JAMESFETT]

Thank you for the information. I use height and weight to calculate body surface area (BSA) and then use BSA to determine normal left ventricle (LV)size (EDD) for BSA. Your BSA is 1.6 square meters , and if you should find your EDD in cms, simply divide the EDD by 1.6 = your LV size per square meter body surface area; normal is 2.7 cm or less. [For example, EDD of 4.2 cm divided by 1.6 = 2.6 cm per square meter BSA, which is normal.]

With only trace protein in urine it is difficult to absolutely diagnose pre-eclampsia, but it is possible because of the associated hypertension. These days there are other tests to do for pre-eclampsia, obstetritians are in the know. At the very least you did have "hypertension of pregnancy." All of those things can be monitored during any subsequent pregnancy--including early recognition of PPCM--with the institution of effective treatment.

Wish you the best.

JD

[beck94]

I just recently had another echo last week. I am still nervous with all I read on the internet about some of the regurgitation problems I have. Here are my results. I am really curious if any of the results could be related to PPCM.

Left atrium 2.9
Left ventricle - diastolic 4.3
Leff ventricle - systolic 2.5
LV ejection fraction 65
Intraventricular septal thickness 1.0
Posterior LV Wall thickness 0.7
IVS thickness/posterior wall 1.4
Right ventricle - diastolic 2.4
Mitral valve flow velocity 1.0
Mitral valve regurgitation 1+
Aortic root 2.5
Aortic valve opening 1.4
Aortic valve flow velocity 0.9
Aortic valve gradient WNL
Tricuspid valve regurgitation 2+
PA systlic pressure 21
Pulmonic valve velocity 0.9
Pulmonic valve gradient WNL
Pulmonic valve regurgitation 2+

Are these findings really abnormal. Will any of the findings be a problem in pregnancy. I have read some scary things with tricuspid valve regurgitation. I am nervous, as I just found out on Monday that I am pregnant. I am terrified of being pregnant with these echo findings and with the way I felt in my previous pregnancy. Also, are these findings consistent wtih valvular heart disease. I get conflicting answers with different doctors.

PS My height is 5 feet 5 and weight is 125 pounds

Thanks Again!

[JAMESFETT]

I don't see anythiing very troubling in your echo report. The tricuspid regurgitation is of uncertain etiology or significance. The mitral regurgitation is inconsequential. Your heart function is excellent. If you do try for another pregnancy stay in close observation with your cardiologist. I don't see evidence of your ever having had PPCM, and even if you did you are in a low risk group for relapse (under 10 % I would think). Best wishes to you as you weigh the risks of another pregnancy and make important decisions. Your safest course (lowest risk) is, of course, not to have another pregnancy.

JD