PPCM - can I believe in my recovery?

In November 1998 I was diagnosed with DCM, probably PPCM, as I had given birth to my third child 5 months earlier. This was found out by pure chanse, as my GP heard a heart murmur and transmitted me to a heart specialist. I was quite chocked, as I had never experienced any physical sympthoms, except for a pulse that was  80. In fact, I believed myself to be a very healthy 40 year old woman, working full-time and breast-feeding my baby.

I was told that I had an EJF of 25 percent and a severely enlarged left heart chamber. A cardiac catheterization a week later showed a higher EJF, 41 percent, but when I made av new ultra sound in december, the EJF was still 25-30 percent.
I was put on medication - Carveldilod and Zestril - and when I had a new ultra sound in march, the heart chamber size was back to normal and the EJF was approx. 50 percent. My doctor told me that this was great, and that I did not need to come back until late-autumn. In the mean time I could do anything I wanted, as long as I did not get pregnant...

Today, I live a very active life. Almost every day, I take a quite rapid 5-6 miles walk in the hills or in the forest, and this never makes me tired. Some days, perhaps one out of ten, I feel a bit weak, especially in the mornings. Those days, I usually have a pulse of -60, and after 20 minutes of exercise, I usually feel better.

I guess everything should be just great. Still, I can't stop worrying. Sometimes I can feel my heart beating against the mattress, and hear my pulse-beats hammering in my head (pulse is normal, though). And I remember that I experienced these sensations before, shortly before I had my diagnosis. Perhaps this is normal, and nothing to worry about. But still my anxiety is rapidly turning our wonderful holiday into a night-mare, and I have no one around

[Cleveland Clinic, MD]

Dear Marie,

Post-Partum (or peripartum) cardiomyopathy is a relatively rare form of heart failure that affects women during or following pregnancy.  Establishing a diagnosis requires 1. The absence of a determinable cause for cardiac failure, 2. Absence of preexisting heart muscle disease, and 3. Time limitations of onset of illness from the last month of pregnancy to the first 5 post-partum months.  Peripartum cardiomyopathy complicates 1 of 1300 to 4000 deliveries in the United States.  This condition may affect women of any race, age, or number of prior deliveries; however, older, multigravida, African American and twin pregnancies are thought to represent predisposing features.  The cause is unknown.  

The treatment is standard heart failure medication (diuretics, digoxin, ACE inhibitors) and in severe cases heart transplant.  Approximately half of patients with this diagnosis will return to normal within 6 months.  There is little risk of recurrence in the absence of repeat pregnancy. You can find additional information in the following articles.  (your local medical library should be able to help you find these). In the meantime enjoy your vacation with some renewed peace of mind.

Lampert, MB Lang RM. Peripartum cardiomyopathy. Am Heart J 1995; 130:860-870.

Huerta EM, Erice A, Espino RF, et al. Postpartum cardiomyopathy and acute myocarditis. Am Heart J 1985; 110:1079-1081.

I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.

If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.