A 38-year-old woman develops severe biventricular heart failure (LVEF 15%) in the last month of her first pregnancy. Echo shows dilated LV with no regional wall motion abnormalities. The most likely diagnosis and the drug that is CONTRAINDICATED in her management is:

• A Postpartum cardiomyopathy; bromocriptine is absolutely contraindicated
• B Postpartum cardiomyopathy; ACE inhibitors are contraindicated during breastfeeding only
• C Hypertensive cardiomyopathy; hydralazine is contraindicated
• D Peripartum cardiomyopathy; ACE inhibitors are contraindicated DURING pregnancy (safe postpartum) ✓

Explanation

Peripartum cardiomyopathy (PPCM) is defined as new-onset HF within the last month of pregnancy or within 5 months postpartum without a prior identifiable cause. ACE inhibitors and ARBs are contraindicated during pregnancy (teratogenic — fetal renal dysgenesis, oligohydramnios) but are first-line therapy postpartum (after delivery). During pregnancy, heart failure is managed with hydralazine + nitrates, beta-blockers (metoprolol), and diuretics. Bromocriptine (dopamine agonist to suppress prolactin) is being studied as an adjunct therapy in PPCM (BOARD trial) but is not yet standard of care; it is not absolutely contraindicated.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.