future pregnancies?

  I am a 34 y.o.woman who in 1993, 3mths after my 2nd. pregancy was diagnosed with post partum cardiomyopathy. I am currently taking monopril and dijoxin in very small doses (20 mgs and 250micrograms respectively). My questions is in various  parts, first, can anyone fully recovery from this disease and how great a risk is a further pregnancy? My disease was (suspect) virul and I have had a very good recovery so far. My cardiologist feels I may be able to be completely drug free in the near future. I have also been off the medication for approx. 1 1/2 yrs, although I've only restarted on the medication recently (approx. 2 mths.)If pregnancy is low risk, could I still be on the current medication and not pose a risk to the unborn child? or what sort of risk may I be imposing on the foetus if on the medication? Has there ever been a case of a further full term pregnancy after diagnosis? and finally what sort of statistics are there in life expectancy after diagnosis?  I would dearly appreciate someone helping me out with these questions.

[CCF CARDIO MD APS]

Dear Nancy,
Yes there are women who completely recover from their postpartum cardiomyopathy, as well there are patients who recover from their post-viral cardiomyopathy.  
I will speak only of peripartum cadiomyopathy as you said you were diagnosed a few months after your second pregnancy and the disease can appear during the third
trimester or within the first 6 months following delivery.  The natural history of this disease is somewhat different from other causes of cardiomyopathy, including viral induced cardiomyopathy.
When recovery from pregnancy induced cardiomyopathy is going to improve or resolve it usually begins it's recovery in the first 6 weeks; about 50% of all cases will spontaneoustly resolve and this is
usually in the first 6 months after diagnosis.  Improvement after the first 6 months is not unheard of, it is just very unlikely; by your history it sounds as if you did recover.  Identifying which patients are
likely to improve is very difficult if not impossible.  In terms of long term prognosis, severe heart failure requiring heart transplantation and death occur in 25-50% of patients with peripartum cardiomyopathy.  
Some studies have suggested that the prognosis is related to whether the heart size (by echo, or chest x-ray) returns to normal following the first bout of congestive heart failure.  If the heart size does not increase
the future pregnancies can be well tolerated, but there is no guarantee that there will not be worsening of the heart failure.  Unfortunately, in that patient who's heart remains enlarged, any future pregnancy will almost surely
lead to worsening congestive heart failure and death.  Thus any woman who recovers as such is encouraged against future pregnancies.  When there was a wave of studies that tested immunosupression(taking drugs that tone down what is believed to be an overactive or chronic inflammation in the heart called "myocarditis" as the cause of the disease)
not too long ago, it was the patients with post partum cadiomyopathy who responded best.  This treatment called immunosupression however requires a myocardial biopsy and is very controversial or better said, is not accepted as proven or beneficial therapy.  
While I am in the process of discouraging you from getting pregnant, you must know that any ace-inhibitor type drug (enalapril, monopril, etc.) is absolutely contraindicated in pregnancy, especially in the first trimester.  
I am a bit unclear as to how you now have the diagnosis of 'viral' cardiomyopathy, when it sounds as if you simply never completely recovered from your first bout and I am thinking it is in your best interest to follow regularly with your physician(preferably a cardiologist who specializes in heart failure), take your medications as prescribed and concentrate on keeping yourself in your best health
especially if you have children already who are currently in great need of your presence.  
It is concerning that you need the drugs again as you say which could be a sign that heart failure is returning and putting you at very high risk of death should you go through another pregnancy; if that is the case any further pregnancy would really be a threat to your life and the drugs you would need to appropriately treat your heart failure are contraindicated in pregnancy because they can and do significant damage to the fetus.  I am sorry if this is not what you wanted to hear
but these are the facts of our current state of medical knowledge which includes studies and anecdotal reports on your disease process.  Information provided in the heart forum is intended for general informational purposes only, actual diagnosis and treatment can only be made by your physician(s).