2. Findings and Diagnosis
28 year old post partum female complaining of recent SOB

35-year-old female with an 8-year history of post- partum cardiomyopathy presents with a history of chest pain. CT of the chest with contrast in an axial projection, at the level of the heart, shows an enlarged left ventricle. The right lower lobe segmental arteries show filling defects and absence of contrast (maroon circle in b), compared to the left lower lobe arteries (white circle b). An external defibrillator is present.
Ashley Davidoff MD TheCommonVein.net 253Lu 136165cL
3. Clinical

35-year-old female with an 8-year history of post- partum cardiomyopathy presents with a history of chest pain. CT of the chest with contrast in an axial projection, at the level of the heart, shows an enlarged left ventricle. The right lower lobe segmental arteries show filling defects and absence of contrast (maroon circle in b), compared to the left lower lobe arteries (white circle b). An external defibrillator is present.
Ashley Davidoff MD TheCommonVein.net 253Lu 136165cL
Page 3 – Info
Table 1: Clinical Definition and Context
Feature | Description |
---|---|
What is it? | A condition of systolic heart failure due to dilated cardiomyopathy arising late in pregnancy or in the early postpartum period. In this case, it coexists with pulmonary embolism, a common complication of the hypercoagulable postpartum state. |
Caused by | Unknown exact etiology; proposed mechanisms include myocardial inflammation, autoimmune responses, hemodynamic stress, and hormonal shifts. PE is caused by venous thromboembolism, often originating from the lower extremities. |
Resulting in | Reduced left ventricular contractility, dilation, and low cardiac output. PE leads to vascular obstruction of pulmonary arteries and impaired gas exchange. |
Structural Changes | Enlarged left ventricle, possible left atrial enlargement; in PE, filling defects in pulmonary arteries and possible right heart strain. |
Functional Changes | Global systolic dysfunction, dyspnea, hypotension, fatigue; PE may cause hypoxia, tachycardia, pleuritic chest pain. |
Diagnosis | |
– Clinical | Dyspnea, orthopnea, edema (cardiomyopathy); pleuritic pain, hemoptysis, tachypnea (PE) |
– Imaging | CT: Dilated LV; CTPA: Pulmonary emboli; Echocardiography: EF ↓ |
– Lab | Elevated BNP, troponin (variable), D-dimer (elevated in PE) |
– Other | ECG: Sinus tachycardia; Echo: LV dilation and low EF; LE Doppler for DVT |
Complications | Heart failure, cardiogenic shock, arrhythmias, recurrent thromboembolism, sudden cardiac death |
Treatment | Supportive: diuretics, beta blockers, ACE inhibitors (if stable); anticoagulation for PE; mechanical support or transplant if refractory |
Table 2: Imaging Patterns and Radiologic Features
Imaging Modality | Findings |
---|---|
CT (Cardiac/Angio) | Dilated LV, filling defects in pulmonary arteries (PE), cardiomegaly |
Echocardiography | Dilated LV, ↓ EF, sometimes mitral regurgitation |
MRI (Cardiac) | Can show myocardial fibrosis or inflammation if myocarditis suspected |
CXR | Enlarged cardiac silhouette, pulmonary edema (if decompensated) |
Key Points & Pearls
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Postpartum cardiomyopathy is a rare but life-threatening condition, often under-recognized in young women with dyspnea.
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Coexistence with pulmonary embolism reflects the dual burden of postpartum physiology: volume overload and hypercoagulability.
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Early diagnosis with CT or echocardiography is essential to guide timely treatment.
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Consider multidisciplinary care in postpartum patients presenting with combined cardiac and respiratory symptoms.
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Full recovery of cardiac function can occur with treatment, but some patients may progress to chronic cardiomyopathy or require advanced heart failure therapies.
4. Historical and Cultural

35-year-old female with an 8-year history of post- partum cardiomyopathy presents with a history of chest pain. CT of the chest with contrast in an axial projection, at the level of the heart, shows an enlarged left ventricle. The right lower lobe segmental arteries show filling defects and absence of contrast (maroon circle in b), compared to the left lower lobe arteries (white circle b). An external defibrillator is present.
Ashley Davidoff MD TheCommonVein.net 253Lu 136165cL
Page 4 – Other: Historical and Cultural Reflections
1. Historical Understanding of Postpartum Heart Failure
Period | Reference | Reflection |
---|---|---|
19th Century | Virchow and Rokitansky | Though the term “peripartum cardiomyopathy” was not used, early pathologists noted cases of sudden cardiac failure in postpartum women, attributing it variably to “exhaustion” or “puerperal fever” without understanding the cardiac cause. |
20th Century (1937) | Demakis et al., American Heart Journal | First systematic description of peripartum cardiomyopathy as a distinct clinical entity characterized by heart failure in the absence of other causes, appearing late in pregnancy or early postpartum. |
2. Literary Allusion: The Heart Under Strain
Work | Author | Relevance |
---|---|---|
“To My Dear and Loving Husband” | Anne Bradstreet (17th-century Puritan poet) | Bradstreet, a mother of eight, wrote about the emotional and physical intensity of motherhood. Her poetry—though not medical—evokes the burdens and vulnerabilities borne by women postpartum, metaphorically paralleling the physiologic demands placed on the heart. |
3. Artistic Representation: The Maternal Body and Vulnerability
Artist | Work | Relevance |
---|---|---|
Käthe Kollwitz | Woman with Dead Child (1903) | A powerful etching reflecting maternal loss and fragility. While not specifically about cardiomyopathy, the image underscores the postpartum body’s vulnerability, evoking the silent struggles many women faced—sometimes unknowingly—from undiagnosed conditions like peripartum cardiomyopathy. |
4. Etymology and Medical Terminology
Term | Origin | Meaning |
---|---|---|
Peripartum | Latin peri- (around) + partum (childbirth) | Refers to the period immediately before and after childbirth |
Cardiomyopathy | Greek kardia (heart) + myo (muscle) + pathy (disease) | Denotes a disease of the heart muscle, often with weakened contractility |
Key Points & Pearls
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The medical recognition of postpartum cardiomyopathy is relatively recent, with early descriptions scattered and often misunderstood.
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Cultural portrayals of maternal fragility, like those of Kollwitz or Bradstreet, can illuminate the invisible tolls of childbirth—now partially understood through diagnoses like PPCM.
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Art and literature help bridge the emotional and physiological realities of motherhood, enriching the clinical appreciation of postpartum disorders.
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The etymology of the term “cardiomyopathy” reinforces its focus on intrinsic muscle disease—distinct from ischemic or valvular pathology.