Viral Myocarditis vs. Peripartum Cardiomyopathy

Last December I was diagnosed with viral myocarditis and was an ECMO candidate when I was 16 weeks pregnant.  Since then my health has recovered fully (according to the many ECHOs I have had done since) but I lost my baby at 23 weeks due to PROM which they attribute to the myocarditis. After looking over my medical records I have noticed the recurring statement "hyperdynamic left heart, and decreased left ventricular function".  I am now concerned that maybe it was PPCM and not viral myocarditis.  Since I am currently trying to conceive again and knowing that the prognosis for subsequent pregnancys are different betweeen myocarditis and PPCM I am hoping you can tell me the differnce between these two conditions.  How is each diagnosed?  Was I too early  in the pregnancy for PPCM to be an issue? Thank you very much for the info.
Carey

[Cleveland Clinic, MD]

Dear Carey,

It can be dificult to distinguish between the two.  The onset and symptoms are nearly identical and the treatment is the same. The echo does not help to differentiate between the two.  If you had a viral like illness before the onset of the heart failure that could indicate more of a viral myocarditis picture.  If a heart biopsy was done it could show changes that are consistent with viral myocarditis but in the absence of biopsy or viral titers I'm not sure the diagnosis can be made with certainity.  It could have been PPCM or viral myocarditis.  I would definately recommend seeing a specialist in heart failure before trying to conceive again.  Best wishes.