A 27-year-old woman presents three months after an uncomplicated vaginal delivery with orthopnea and peripheral edema. She had no cardiac history before pregnancy. Echocardiography shows a dilated left ventricle with LVEF 31% and no valvular or ischemic abnormality. What is the most likely diagnosis?

• A Peripartum cardiomyopathy ✓
• B Viral myocarditis
• C Amniotic fluid embolism
• D Postpartum pulmonary edema from tocolytics

Explanation

Peripartum cardiomyopathy is defined as new heart failure with LVEF below 45% arising between the last month of pregnancy and five months postpartum, with no other identifiable cause. This timing window is the defining criterion and excludes myocarditis, which has no temporal link to delivery. Management follows standard HFrEF therapy, and bromocriptine may be added because a cleaved prolactin fragment is implicated in its pathogenesis.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.