Why did I get cardiomyopathy at age 24?

[blueclare]

I'm 30 years old.  When I was 24, I developed shortness of breath, swelling, etc., and was finally correctly diagnosed with congestive heart failure.  My ejection fraction was about 10% by the time I was admitted to the hospital.  I had a severely enlarged heart.  I was discharged after 7 days and treated aggressively with medication.  Within 9 months, my EF was up to 65%.   I've never had a biopsy or any other heart surgery.

When I was 26, I became pregnant.  I had to go off most heart meds, and I developed heart failure again once I approached the 2nd trimester.  My EF went from 65% to 40% in just 3 weeks and I terminated the pregnancy at 15 weeks.  

I see my cardiologist annually and get an echo annually.  I take lisinopril, labetalol, lasix, spironolactone.  Since my pregnancy, my EF is around 55% each year.  All my echos since the hospitalization show mitral valve regurgitation (mild or moderate).  I have palpitations and an irregular heartbeat.  My EEGs show damage to the heart.  

Being so young, my arteries are perfect without blockage.  I've never smoked, drank, or use drugs.  I am overweight, but engage in light activity like walking my dogs most days of the week.  I consistently have chest pain when I exercise too strenuously.

Prior to my cardiomyopathy diagnosis at age 24, I had some high blood pressure over several months each: maybe 140 or 145/85.  But then I was taken off birth control and it went down, so I never took high blood pressure pills before the heart failure.  

What's wrong with me?  Why is my heart like that?  What's my prognosis?  Am I always going to have to take these medications?  Is there a cure or at least a surgery to correct this?  What should I be asking my cardiologist about?  Am I too young to have developed cardiomyopathy due to high blood pressure?  

[CCFHeartMD 26]

You are much too young to have developed heart failure secondary to high blood pressure (hypertensive heart disease leading to dilated cardiomyopathy) and your blood pressure does not sound like it was significantly elevated anyway.  Unfortunately, most specific causes of idiopathic cardiomyopathy are never determined.  Most commonly the causes are a viral infection (which usually has resolved before the patient presents with symptoms of heart failure), alcohol use (usually heavy), or some other undetermined insult to the heart.  Peripartum cardiomyopathy (heart failure associated with pregnancy) is a well known problem for some women, but if you developed heart failure the first time prior to being pregnant, this is unlikely the primary culprit.  You may have to take the medications long term as they may be the reason your ejection fraction has recovered (and the fact that it did is a good prognostic sign!).  There is no cure or surgery to correct this type of heart failure other than taking an optimal medical regimen, which it sounds like you are.  Some patients who have refractory heart failure and their ejection fraction never recovers despite optimal medical therapy often are considered for heart transplantation, but that is not necessary in someone who's ejection fraction has recovered.

[blueclare]

Oh, and it was not dilated cardiomyopathy.  Doctors suspected it was viral but couldn't find any known cause at the time.