Signs and Symptoms
Symptoms usually include one or more of the following: orthopnea (difficulty breathing while lying flat), dyspnea (shortness of breath on exertion), pitting edema (swelling), cough, frequent night-time urination, excessive weight gain during the last month of pregnancy (1-2+ kg/week; two to four or more pounds per week), palpitations (sensation of racing heart-rate, skipping beats, long pauses between beats, or fluttering), and chest pain.
The shortness of breath is often described by PPCM patients as the inability to take a deep or full breath or to get enough air into the lungs. Also, patients often describe the need to prop themselves up overnight by using two or more pillows in order to breathe better. These symptoms, swelling, and/or cough may be indications of pulmonary edema (fluid in the lungs) resulting from acute heart failure and PPCM.
Unfortunately, patients and clinicians sometimes dismiss early symptoms because they appear to be typical of normal pregnancy. Yet, early detection and treatment are critically important to the patient with PPCM. Delays in diagnosis and treatment of PPCM are associated with increased morbidity and mortality.
It is important to note that occasionally patients present with other signs or symptoms. This is demonstrated by one report of a woman with liver failure five weeks postpartum who was being considered for liver transplant. An echocardiogram was performed and revealed PPCM and heart failure as the cause of her severe liver failure. Conventional heart failure medications were administered. She survived and completely recovered from both the liver failure and PPCM.
It is also quite common for women to present with evidence of having an embolus (clot) passing from the heart to a vital organ, causing such complications as stroke, loss of circulation to a limb, even coronary artery occlusion (blockage) with typical myocardial infarction (heart attack).
For these reasons, it is paramount that clinicians hold a high suspicion of PPCM in any peri- or postpartum patient where unusual or unexplained symptoms or presentations occur.
The following is a screening tool developed by James D. Fett, MD, which may be useful to patients and medical professionals in determining the need to take further action to diagnose symptoms:
| Focused medical history for PPCM screening, looking for early symptoms of heart failure, during last month of pregnancy: |
|---|
| 1. Orthopnea (difficulty breathing while lying flat): |
| a.) None = 0 points; b.) Need to elevate head = 1 point; c.) Need to elevate upper body 45° or more = 2 points |
| 2. Dyspnea (shortness of breath on exertion): |
| a.) None = 0 points; b.) Climbing 8 or more steps = 1 point; c.) Walking on level = 2 points |
| 3. Unexplained cough: |
| a.) None = 0 points; b.) Night-time = 1 point; c.) Day and night = 2 points |
| 4. Swelling (pitting edema) lower extremities: |
| a.) None = 0 points; b.) Below knee = 1 point; c.) Above and below knee and/or hands/face = 2 points. |
| 5. Excessive weight gain during last month of pregnancy: |
| a.) Under 2 pounds per week = 0 points; b.) 2 to 4 pounds per week = 1 point; c.) over 4 pounds per week = 2 points. |
| 6. Palpitations (sensation of irregular heart beats): |
| a.) None = 0 points; b.) When lying down at night = 1 point; c.) Day and night, any position = 2 points |
| Scoring and Action: |
| 0 - 2 = low risk—continue observation |
| 3 - 4 = mild risk—consider doing blood BNP and CRP; echocardiogram if BNP and CRP are elevated |
| 5 or more = high risk—do blood BNP, CRP, and echocardiogram |
Read more about this topic: Peripartum Cardiomyopathy
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