What are the symptoms of pregnancy-induced cardiomyopathy in women during or after pregnancy?

Symptoms of Pregnancy-Induced (Peripartum) Cardiomyopathy

Women with peripartum cardiomyopathy typically present with heart failure symptoms including marked fluid retention with pedal edema, dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and persistent cough, though these symptoms are often initially mistaken for normal pregnancy-related changes. 1

Primary Clinical Manifestations

The clinical presentation mirrors other forms of systolic heart failure but occurs in a specific temporal window:

Classic Heart Failure Symptoms

• Dyspnea on exertion - the most common presenting symptom 1
• Orthopnea - difficulty breathing when lying flat 1
• Paroxysmal nocturnal dyspnea - sudden nighttime breathlessness 1
• Persistent cough - often non-productive 1
• Marked pedal edema - bilateral leg swelling beyond normal pregnancy edema 1

Additional Symptoms

• Abdominal discomfort secondary to hepatic congestion from right heart failure 1
• Praecordial chest pain - though myocardial infarction is rare in this population 1
• Palpitations - may indicate arrhythmias 1
• Dizziness and postural hypotension - particularly in advanced stages 1
• General fatigue and tiredness - often attributed incorrectly to normal postpartum exhaustion 1

Critical Diagnostic Pitfall

The major clinical challenge is that early symptoms of peripartum cardiomyopathy closely mimic normal physiological findings of late pregnancy and the postpartum period. 1 Women and their healthcare providers frequently attribute dyspnea, edema, and fatigue to normal pregnancy-related changes or postpartum recovery, leading to delayed diagnosis. 1 This is particularly problematic because patients may also be anemic, further confounding the clinical picture. 1

Less Common Presentations

While heart failure with fluid retention is the typical presentation, some women present with:

• Embolic stroke - due to left ventricular thrombus formation 1
• Arrhythmias - including ventricular tachycardia or ventricular fibrillation 1
• Sudden cardiac arrest - in severe cases 1

Temporal Pattern of Symptom Onset

The majority (78%) of patients develop symptoms within the first 4 months postpartum, with a clear peak occurring 2-62 days after delivery. 1, 2 Only 9% present during the last month of pregnancy, and 13% present either before the last month of pregnancy or more than 4 months postpartum. 1, 2 The worst cases tend to develop during the first few days postpartum and may present with fulminating heart failure. 1

Severity Spectrum

The clinical presentation ranges from mild symptoms to life-threatening cardiac failure:

• Mild cases - may have only subtle symptoms that are easily overlooked 1
• Moderate cases - present with classic heart failure symptoms requiring standard medical therapy 1
• Severe/fulminant cases - require inotropic support, ventricular assist devices, or even cardiac transplantation 1, 3

Key Clinical Context

Symptoms should raise particular concern when they occur in previously healthy women without pre-existing heart disease, especially when presenting in the characteristic temporal window of the last month of pregnancy through 5 months postpartum. 1 The diagnosis requires echocardiographic confirmation showing left ventricular systolic dysfunction with ejection fraction nearly always reduced below 45%. 1, 2