Myocarditis or Postpartum Cariomyopathy and pregnancy

[Katy D.]

I am a 25yr old female interested in attempting another pregnancy.  I have one 8yr old son and had no problems with that pregnancy or delivery.  Two years ago, I had a miscarriage at 12wks of pregnancy.  Two months later, while undergoing treatment for the flu and taking antibiotics for strep-throat, I was admitted to the ER with chest pain and a squeezing sensation in my chest and throat.  I had an abnormal EKG and high blood enzyme level.  I was admitted to the hospital and placed in ICU with a myocardial infarction.  Later, I had a heart catherization that ruled out cardiovascular disease and the cardiologist saw some inflammation/dialation of the heart muscle.  He told me that I had myocarditis.  About a week later, I returned home.  By a month later, my heart had returned completely to normal.  I saw the cardiologist for a full year after my cardiac event.  I could never seem to get anything more out of him than I am doing fine.  I went back to my doctor that I used before the attack, an internist, and from looking at my records from the cardiologist (he hasn't seen the hospital records yet), and running several x-rays and echos he doubts that I had a heart attack and doesn't see any reason that I should not try to get pregnant.  He said that my heart looks completely normal with the exception of a small valve prolapse with trace regurgitation (which I had before the attack).  My problem is this:  In all of my research, I am wondering if I wasn't misdiagnosed and if I actually had postpartum cardiomyopathy.  I am concerned that I may put myself at risk by attempting another pregnancy.  What is my risk over and above that of a person that has never had these problems?  I must say that this pregnancy is not necessary as I have a full life without another child, but I would like the option.  Can you make any recommendations for me?

Also, if it makes any difference, I am hypothyroid and taking synthroid.  I take no other medication and never have for any heart problems other than endocin at the beginning.

Thanks so much,
Katy
Houston, TX

[Cleveland Clinic, MD]

I doubt that you had postpartum cardiomyopathy.  It would be unusual following a first trimester miscarriage.  It dosen't sound to me like there would be a contraindication to another pregnanc but, of course, the "clearance" should be from your doctor.

[Katy D.]

Doctor,

Thank you so much for your reply.  As far as my doctor is concerned, I am completely normal.  He has no problems with me getting pregnant.  I was just worried and being cautious.  So, are you saying that I have no additional risks over that of a person that has never had myocarditis?

Thanks again,
Katy
Houston, TX

[ginny]

Dear Katy,
I've done some reading on my own condition-Antiphospholipid Syndrome-and some of the symptoms of this problem you have.  (i.e. History of miscarriage, and ischemic event.)  You might have a clotting disorder-your blood tends to clot.  If you are contemplating another pregnancy, I would suggest you see your Ob/Gyn.  He will run diagnostic tests for this clotting problem, and if found, will put you on low dose aspirin and/or warfirin(Depending on your blood level of clot promoting antibodies.)  This treatment is needed prior to conception and for at least 12 weeks after conception(Maybe the whole pregnancy depending on your blood levels.).  This will cut down your risk of miscarriage and preclampsia/Eclampsia.  If you don't have this  problem, nothing is lost and you have gained some peace of mind.  
Sincerely,
Ginny

[Cleveland Clinic, MD]

Katy - no additional risks (except the risk of more diapers!)