Dr Fett - Is Fever Before PPCM Symptoms Appear Common?

[ncwahoos]

Hello Dr. Fett,

I have been reading the message board postings from the past and noticed that several people have mentioned developing a fever during the onset of their PPCM symptoms. I am curious if that somehow ties into the illness as I was asymptomatic throughout my pregnancy and delivery but then developed a sudden fever the evening after my daughter was born. I had very severe chills and told the nurse who took my temperature and determined I had a fever, but there was no cause evident. That seemed to be when all the symptoms started as I started to retain water followed by development of the abdominal pressure that made it hard for me to breath. The fever subsided within a day and I was discharged anyway on Sunday morning but returned to the ER Thursday evening and then was admitted to the hospital on Friday (5 days from discharge) due to the swelling and inability to breath.

Anyway, this illness baffles me and since I have no prior history of heart problems I thought I would ask since I have seen suggestions that PPCM may be related to the autoimmune system and wondered if you think the fevers folks developed are some sort of autoimmune system response.

Thanks,
Stephanie
:confused:

[JAMESFETT]

Fever is not a usual or essential part of PPCM. It is possible that PPCM is tripped off by a viral infection some time before heart failure occurs. In that situation a fever would/could be present. Heart failure may also be complicated by super-imposed pneumonia, which then could give fever. Around delivery urinary tract infections are common, that could give fever. Uterine infections postpartum could give fever. So there are many associated conditions that may contribute fever to the picture. It all has to be sorted out. But with PPCM alone we usually don't see much or any fever and the white blood count is normal. I think there are 3 essential elements to the development of PPCM:

1)Pregnancy associated changes of immune system and hormone system,
2)Genetic susceptibility, with certain genetic patterns more susceptible than others, particularly to autoimmune processes, and
3)Precipitating factor, which I think is a cardiotropic viral infection, either recent or remote and activated. But this trigger could be non-viral also.

JD

[Delores]

3)Precipitating factor, which I think is a cardiotropic viral infection, either recent or remote and activated. But this trigger could be non-viral also.

Dr. Fett. I had a history of PVC's before my pregnancy. Could PVC's be indicative of a virus of the heart muscle? Does the virus ever go away after recovery from PPCM?

Thanks. Delores :)

[JAMESFETT]

Yes, initial evidence is that with healing the virus goes away. Not enough research has yet been done to confirm that definitively, but a researcher in German found viral particles in 6 out of 6 PPCM patients on endomyocardial biopsy, all recovered, and in repeat biopsy all cleared the viral particles. In known viral myocarditis apart from PPCM the same is true; but in some the virus lingers with transition to a chronic phase without complete healing. PVC's are so common in healthy people that it would be most difficult to say if any you had before PPCM diagnosis had anything to do with developing PPCM.

JD