Four years ago, I gave birth to my second child after an uneventful pregnancy. About 4 days postpartum,I developed
severe pain under my right lower ribs. I was also extremely
swollen esp. the lower legs, ankles and somewhat in the feet.
I had taken Toporol XL during my pregnancy for tachacardia and
palpatations. I was told that this was caused by Mitral Valve
Prolapse. Results of an echo done 1 week after childbirth are as follows; Mild concentric left ventricular hypertrophy with normal wall motion and systolic function. EF was 60%. Severe tricuspid regurgitation, mild mitral regurgitation, mild aortic insufficiency, trace pulmonic insufficiency.Left ventricle is normal size although there is boderline hypertrophy in the septum and posterior walls measuring 1.1cm. Atrials normal, right venticle normal. No meds or treatment. 3 weeks later another echo showed normal left ventricle, EF 50 to 60%,mild aortic insufficiency, mitral and tricuspid regurg., and pulmonic insuff.
I got pregnant 2 months postpartum and again had a normal pregnancy except for the palp. and tachy. which were kept under control by the Toporol. The third child was born 11 months after
the second. About 4 days postpartum I once again began swelling
and developed pain under the right ribs. Blood work and echos
both times showed enlarged liver, elevated liver count and
inflamed gallbladder. Echo done about a week later showed moderate aortic insuff., mild mitral regurg. trace pulmonic insuff. , moderate tricuspid regurg. Also left to right intracardiac shunt(atrial septal defect).Mild concentric left ventricular hypertrophy, normal function and EF greater than 55%,
Right ventricle and left atrium at upper limits of normal 4.0cm.
In the last 2 years I have had many echos(all normal),TEE(normal),Stress echos and nuclear stress test(normal).
I have been told that there is doubt that I had postpartum cardiomopathy at all and if I did it has completely resolved.
Both of these pregnancies were induced with antibiotics given
during labor because of the MVP. I am now pregnant again and I
am scared to death. Was this cardiomopathy? If not, do you have
an opinion as to what it could have been and is there anything I
should be doing to prevent this from happening again. Thank you
so much for your help.
Unless I misread your echo reports, there is nothing to suggest postpartum cardiomyopathy. Your left ventricular function has always been pretty normal - this is inconsistent with a diagnosis of peripartum cardiomyopathy. It is impossible to say what it was that caused your symptoms, however, so I can not think of any specific precautions other than remaining under close watch by your obstetrician.
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