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Two cases of postpartum cardiomyopathy initially misdiagnosed for pulmonary embolism

[Deux cas de cardiomyopathie du postpartum diagnostiqués d'abord comme embolie pulmonaire]

Magdalena Lasinska-Kowara, MD^*, Maria Dudziak, MD, PhD and Janina Suchorzewska, MD, PhD^*

^* From the Department of Anaesthesia and Intensive Care and the
Non-Invasive Cardiovascular DiagnosticUnit Institute of Cardiology Medical University of Gdansk Poland.

Address correspondence to:Dr. Magdalena Lasinska-Kowara, Department of Anaesthesia and Intensive Care, Medical University of Gdansk, ul. Dêbinki 7, 80-952 Gdansk, Poland. Phone: ++ 48 58 349 24 06; Fax: ++ 48 58 346 11 82; E-mail: magda{at}amg.gda.pl Work was carried out at the Department of Anaesthesia and Intensive Care with the cooperation of the Non- invasive Cardiovascular Diagnostic Unit, Medical University of Gdansk, Poland.

Purpose: To underline the crucial role of urgent echocardiography in the differential diagnosis of acute respiratory and/or circulatory failure in the postpartum period.

Clinical features: A 24-yr-old woman was admitted to the intensive care unit (ICU) with a preliminary diagnosis of pulmonary embolism (PE) one week after Cesarean section. Neither computerized tomography nor Doppler sonography showed any signs of deep venous thrombosis or PE. In the ICU she required intubation and ventilatory support for acute respiratory and circulatory failure. Bedside echocardiography revealed features of left ventricular failure. A diagnosis of postpartum cardiomyopathy (PPCM) was made, appropriate treatment instituted and the patient soon improved.

A 29-yr-old, previously healthy primipara presented at the Maternity Clinic on the fourth postpartum day complaining of increasing dyspnea and fatigue. Within eight hours she required intubation, ventilatory support and subsequent defibrillation due to cardiac arrest. She was transferred to the ICU with a preliminary diagnosis of PE. She developed pulmonary edema followed by cardiac arrest with successful resuscitation. Bedside echocardiography revealed a left ventricular ejection fraction below 30% with an increased systolic diameter of the left ventricle, restrictive diastolic abnormalities and no signs of pulmonary hypertension. Peripartum cardiomyopathy was diagnosed and supportive treatment for heart failure was instituted.

Conclusion: It is possible to misdiagnose postpartum cardiomyopathy for PE. An error in diagnosis is life-threatening for the patient. Echocardiography is a valuable tool in the differential diagnosis. As a noninvasive procedure, it should be performed at the bedside as soon as possible to institute proper treatment and to avoid potentially fatal errors.

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				B Quinn, B Doyle, and J McInerney Postnatal pre-cordial pain. Pulmonary embolism or peripartum cardiomyopathy Emerg. Med. J., November 1, 2004; 21(6): 746 - 747. [Full Text] [PDF]