Is it really PPCM?

[RJsmommy]

Dr Fett:

I just read your answer to a previous post and you gave a list of other causes for the dilated cardiomyopathy that have to be ruled out prior to calling the condition PPCM. In my situation, I started with high blood pressure on 12/29/08 at my OBs office. On 12/31/08 I was at a NST (I was getting them 2xweek due to my son being IUGR) and my BP was high so they admitted me to L&D for monitoring. I felt fine (no headaches, SOB). I did have some lower extremity swelling. My OB was pushing fluids on me, but it was having no effect on my BP. Instead, I was having no output, which ended up in a STAT C/S on 1/1/09.

After delivery (where they pushed in 2 more bags of fluid), I had SOB and my O2 sats were in the 80s. I was tachycardic to the 140s. I had gained over 30 lbs of fluid in the last 2 weeks.

They were thinking it was a respiratory problem initially due to the extra fluid. It wasn't until 1/3/09 that they did an ECHO (because I wasn't improving) and saw that my EF was 26% and I had cardiomyopathy.

I guess my question is, how could they rule out fluid overload as the cause? Any insight you have would be appreciated.

[JAMESFETT]

Simple fluid overload by itself does not give reduced EF. Your LVEF of 26 % reflects a cardiomyopathy and the fluid could not be handled by a compromised heart. With hypertension one must be sure the heart muscle wall is not thickened, reflecting chronic stress, such as may be caused by hypertension. I assume your measured on echo LV posterior wall and interventricular septal wall did not exceed 12 mm; if it did, one could think maybe hypertension caused the heart failure. Otherwise, PPCM seems very likely.

JD

[RJsmommy]

Thanks for the information

[JAMESFETT]

One way to separate respiratory problems from heart failure problems, aside from details of physical exam, is to test the blood for B-type natriuretic peptide (BNP). With respiratory problems the serum BNP is below the cut-off range, and with heart failure problems the serum BNP is almost always above the cut-off range for the particular lab test used. It is an inexpensive lab test, and used frequently in Emergency Room evaluations, since the issue can be confusing. I also encourage the use of serum BNP to monitor response to treatment and in subsequent pregnancies to have an early clue about relapse of heart failure. Do you know if you had a serum BNP done, and do you know the level?

JD

[RJsmommy]

I did have the test done routinely while I was hospitalized. I don't remember the exact value, but I know it was over 1000 initially. By the time I was discharged, 2 weeks after delivery, it was less than 100.