The young woman came to our outpatient clinic every year for a check-up after a hole in her heart septum was closed as a child. At one of the appointments she told me she was pregnant. As usual, a cardiac ultrasound was performed. The result showed that the organ was not performing at its full potential. I called the woman in again four weeks later. At the appointment she said she felt weak, had difficulty breathing, had rapid heartbeat and had water in her legs. Her heart was obviously weakened.
I thought about it: A common cause of shortness of breath is a pulmonary embolism, in which a clot blocks a pulmonary artery or its branches. In fact, blood can actually clot during pregnancy. One cause is hormonal changes, another is vena cava compression syndrome. The child in the womb presses on a large vein, causing blood to pool in the lower half of the woman’s body. Inflammation of the heart muscle could also cause the symptoms. I ruled out the pulmonary embolism using labs and imaging. The inflammation levels were normal and no pathogens could be detected, so myocarditis was unlikely.
Was the woman possibly suffering from pregnancy-related heart failure? In rare cases, cardiac output decreases during pregnancy or in the first few months afterwards. Around one in 3,000 women in this country is affected by what is known as peripartum cardiomyopathy (PPCM).
Typical symptoms include shortness of breath, water retention, fatigue, fatigue and a racing heart. They initially only occur with heavy exertion, later with little exertion or even at rest. Mild symptoms such as these are possible even during a normal pregnancy and are therefore easily overlooked. Here I was alarmed because the complaints were increasing. The heart, as the new ultrasound showed, was now beating even weaker.
I increased the heart strengthening medication the woman was already taking. From then on we checked the heart function weekly. A little later she suffered from shortness of breath without being particularly active. Together we decided to deliver the baby early via cesarean section. Everything went well.
The causes of PPCM have not yet been clearly clarified. I spoke to Dr. about the clinical picture and the special features of the female heart. Suzann Kirschner-Brouns wrote a book (“Heart Consultation”, 2023). A possible cause is an existing predisposition to heart failure, which first becomes apparent during pregnancy. Prolactin can also play a role: the pituitary gland produces more of the breastfeeding hormone in the last weeks of pregnancy and after birth. In those affected, prolactin is broken down incorrectly: the cleavage products trigger a pathological reaction in the heart, which extremely weakens the organ. In addition to the heart-strengthening medication, those affected receive a prolactin blocker. This means they can no longer breastfeed, but the damaging effects of the hormone are stopped.
In many women, the heart recovers quickly with this medication. Not so with this patient. She needed an artificial heart and was placed on the waiting list for a heart transplant. After two years of waiting, we transplanted a heart into her. Today she is doing very well. We advised against another pregnancy. My tip: Doctors should also think about this clinical picture if a pregnant woman or woman who has recently given birth has one or more of the non-specific symptoms.
The diagnosis is also available to listen to: The podcast of the same name with stern editor Dr. You can listen to Anika Geisler music every two weeks for free via the RTL app or wherever podcasts are available
