Peripartum cardiomyopathy (PPCM) is a rare but serious heart condition that affects women during the last month of pregnancy or within the first five months after giving birth. It involves the weakening of the heart muscle, specifically the left ventricle, which reduces the heart’s ability to pump blood effectively. This can lead to heart failure and a range of symptoms that often resemble those of other heart or lung conditions, making early recognition critical.
The symptoms of peripartum cardiomyopathy typically develop gradually and can be subtle at first, often mistaken for normal pregnancy or postpartum changes. The most common early symptom is **exertional dyspnea**, which means shortness of breath during physical activity. Women may notice that they become unusually breathless when walking or climbing stairs, something that wasn’t a problem before pregnancy or delivery. This happens because the weakened heart struggles to meet the increased oxygen demand of the body.
Another hallmark symptom is **orthopnea**, which is difficulty breathing when lying flat. Many women with PPCM find they need to prop themselves up with pillows to sleep comfortably because lying down causes fluid to accumulate in the lungs, making breathing harder. This symptom reflects congestive heart failure, where the heart’s reduced pumping ability causes blood to back up into the lungs.
Women may also experience **paroxysmal nocturnal dyspnea**, which is sudden episodes of severe shortness of breath that wake them up at night. This can be frightening and is a sign that fluid is building up in the lungs due to poor heart function.
**Swelling (edema)** is another common symptom, especially in the legs, ankles, and feet. This swelling occurs because the heart’s reduced pumping ability causes fluid to leak out of blood vessels into surrounding tissues. In severe cases, swelling can extend to the abdomen or cause generalized puffiness.
**Fatigue and weakness** are frequently reported. Women with PPCM often feel unusually tired and unable to perform daily tasks or care for their newborns as they normally would. This fatigue results from the heart’s inability to supply enough oxygen-rich blood to the muscles and organs.
Some women may experience **chest pain or discomfort**, which can be sharp or dull and may worsen with exertion or lying down. This symptom can be confused with other causes of chest pain, but in PPCM it reflects the strain on the heart muscle.
Other signs include **palpitations**, or the sensation of a racing, fluttering, or irregular heartbeat. This occurs because the damaged heart muscle can disrupt the normal electrical signals that control heart rhythm.
Physical examination may reveal **jugular venous distension**, where the veins in the neck appear swollen due to increased pressure in the heart. Lung examination might detect **pulmonary rales**, which are crackling sounds indicating fluid in the lungs. The heart’s apex beat may be displaced downward and outward, reflecting an enlarged heart.
In some cases, women may develop **cough**, sometimes producing frothy or blood-tinged sputum, which is a sign of pulmonary edema (fluid in the lungs). Severe fluid retention can also cause abdominal discomfort or bloating due to liver congestion.
Symptoms usually appear within the first month after delivery but can develop anytime up to five months postpartum. The onset can be sudden or gradual, and severity varies widely. Some women experience mild symptoms that improve with treatment, while others develop severe heart failure requiring intensive care.
Because many symptoms overlap with normal postpartum changes or other conditions like anxiety, exhaustion, or respiratory infections, PPCM can be difficult to diagnose early. Persistent or worsening shortness of breath, swelling, fatigue, chest pain, or palpitations after delivery should prompt medical evaluation.
In summary, the symptoms of peripartum cardiomyopathy include:
– **Exertional shortness of breath (dyspnea)**
– **Difficulty breathing when lying flat (orthopnea)**
