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Re: Cardiomyopathy after childbirth

Posted By CCF CARDIO MD - DLB on December 31, 1998 at 11:54:00:

In Reply to: Cardiomyopathy after childbirth posted by Marie on December 31, 1998 at 05:44:13:

In May 27, I gave birth to my 3rd child. I worked full-time during most of the pregnancy, but in the last 1-2 months I felt tired, shortbreathed, had high pulse (heart-beat) but normal bloodpressure, and swollen feet.
After the pregnancy I felt totally recovered,and in a very good shape for a woman of 40, working full-time and breastfeeding her baby.
In mid-november, still feeling absolutely healthy, I could hear a slight "murmur" from my chest and went to see a doctor. I ended up in hospital, diagnosed with dilated cardiomyopathy, a very enlarged left side heartchamber (sorry, do not know the correct word in enlish) and an ultra sound EF of approx. 25 percent. However, my only physical sympthom was a high pulse. After 2 days medication (Zestril + betareceptorblocking Kredex) the pulse was almost normal, and the vesicular murmur could not be heard, even when using a cardiology stethoscope (the heart murmur has not been heard eversince, although 4 different cardiologists have tried to locate it).
I have no arrythmias son my ECG.
In mid-december I had a cardiac catheterization (is that the correct word?) which shoved no sign of coronary artery illness. My EF was measured to 41 percent.
In late december, I had a new ultra sound, which measured an EF of 28 percent, but my doctor told me that ultrasound and cath. often gives different EF results, and that I could not expect any reliable effects of the treatment for a while yet. I had a bloodpressure of 115/60 and heart beat of approx. 70.
My doctor has mentioned peripartum cardiomyopathy as one of the possible diagnosis. He has told med that I have a fair, or good, chance to live to see my baby reach the age of 20.
All the time I have felt very physically healthy. Even if I walk rapidly for 2 miles or bike for an hour on flat ground, I do not feel mor affected or short-breathed than my normally healthy husband. However, mentally I am still almost chocked, and I fear the future and the possibility of dying away fro my children.
This is my history. My questions are the following:
1- What do you think om my prognosis?
2 - I have learned that approx. one third of the patients deteriorates, in spite of the medication. The rest keep stable, or even recover partially. How long must I wait before I know in which of these categories I belong?
3 - Is the prognosis worse if I have a peripartum CM and "only" stays stable (I e does not recover). I have heard of an average survival of only 4,7 years. Is that true?
4 - How far can a person recover? I have heard of totally recovery, but my doctor has never mentioned that possibility. Could I get healthy enough to have a normal life duration?
5- Is there a big risk of sudden death?
6 - What does the different EF results mean? Which is most reliable, the ultra sound or the cath. EF? Is 28/41 a bad, medium or light condition?
7 - My doctor says that a glass of red wine is quite good for my heart, but I have also read that alcohol should be avoided. Which is correct?
I hope that you, in spite of the language difficulties, will be able to answer my questions, as I feel very frightened and confused by all the different information I have achieved.
Kind regards

Dear Marie
1. Since you have no symptoms, your prognosis is excellent.
2. In six months or so, it will be easier to predict if your heart will recover.
3. Women with peripartum cardiomyopathy that have symptoms of heart failure do tend to do poorly. That does not apply to you though, since you have no symptoms, even with a reasonable degree of physical exertion.
4. The chances are small, but your heart could recover fully. Even if it does not, as long as you do not develop symptoms, you should do fine.
5. In general, patients with low EFs do have a higher risk of sudden death than those that have normal EFs, but this is not necessarily true for an individual patient.
6. EF tends to be different on cath and on echo. I would not say one is more accurate, they are just different ways of making a measurement. Yours sounds like a medium level of dysfunction. Just so you know, a normal EF is about 65%, not a 100%.
7. I think you should avoid alcohol. It is bad for people with weak hearts. Some doctors believe small amounts of red wine are good for patients with diseased coronary arteries, but you do not have that problem anyway.
I hope this has been useful. I wish you the best of luck.
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.

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