Considerations in the postpartum period: It is important to retain an index of suspicion for cardiac disease not only during pregnancy but also in the postpartum period. It is not uncommon for women to present after the customary 4– to 8-week postpartum period with new or worsening symptoms that may be representative of pregnancy-related cardiomyopathy (ie, peripartum cardiomyopathy). Peripartum cardiomyopathy is defined as left ventricular systolic dysfunction (with an ejection fraction <45%) that is diagnosed during the last month of pregnancy or within 5 months postpartum without any identifiable cause of heart failure.24 Other diagnostic echocardiographic findings include a left ventricular end-diastolic dimension >2.7 cm/m2 or fractional shortening of <30% by M-mode echocardiography.25 These women typically present with symptoms that are often dismissed. Delays in diagnosis and appropriate treatment may result in devastating consequences.3
Pregnancy mimics heart disease. Normal physiologic complaints of pregnancy overlap with cardiac-related symptoms. In order to improve outcomes in mothers with preexisting or newly diagnosed cardiac conditions, it is imperative for ob/gyns, primary care physicians, and emergency room physicians to keep cardiac disease in the differential diagnosis of any pregnant or postpartum woman who has delivered within the previous year. Presence of cardiac symptoms should prompt further testing, appropriate referrals, and follow up.
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