A 29-year-old woman develops progressive dyspnea and orthopnea in the last month of pregnancy. Echocardiogram shows LVEF 30%, global hypokinesia, and no valvular abnormality. Which is the most likely diagnosis and what is a key distinguishing feature from other dilated cardiomyopathies?
- A Peripartum cardiomyopathy; onset in last month of pregnancy or early postpartum with no other cause ✓
- B Familial dilated cardiomyopathy; autosomal dominant inheritance pattern
- C Myocarditis; preceded by viral prodrome with fever and myalgias
- D Hypertensive disorder of pregnancy; proteinuria and hypertension >200/110 mmHg
Correct answer: A. Peripartum cardiomyopathy; onset in last month of pregnancy or early postpartum with no other cause
Explanation
Peripartum cardiomyopathy is defined as idiopathic cardiomyopathy presenting in the last month of pregnancy or within 5 months postpartum, with LVEF <45% and no other cause of HF. This timing distinguishes it from other dilated cardiomyopathies. Approximately 50% of patients show complete or near-complete recovery of LVEF within 6 months, which is a distinguishing feature. Familial DCM lacks this temporal relationship. Myocarditis may present similarly but lacks the specific peripartum window.
Reference: Braunwald's Heart Disease, 12th ed.
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