Case Report

Diagnosing Peripartum Cardiomyopathy in a Resource-Limited Setting, a Clinical Perspective: Case Report

Tyfur Rahman* and Kazi Nazratun Nomany Tahia

Published: 29 March, 2024 | Volume 9 - Issue 1 | Pages: 058-060

Peripartum cardiomyopathy is a rare case of heart failure with reduced ejection fraction and is considered a diagnosis of exclusion. The symptoms of heart failure in patients with peripartum cardiomyopathy can mimic the physiologic conditions of normal pregnancy. In an acute decompensated state, PPCM can present with acute severe upper abdominal or epigastric pain. We are presenting a 24-year-old female with no personal or family history of heart disease and no identifiable risk factor for PPCM. Based on her initial presentation in the emergency department, a diagnosis of acute severe pancreatitis was sought, and she was referred to the Intensive Care Unit. After further evaluation of the serological tests and imaging, she was eventually diagnosed as a case of PPCM. We emphasize the rare nature of the disease with a diverse presentation which poses a diagnostic challenge, especially in a resource-limited setting where advanced diagnostic tools may be restricted and socioeconomic condition poses a barrier to further patient evaluation. This case exemplifies the infrequent occurrence and atypical manifestation, presenting a learning opportunity for future clinicians.

Read Full Article HTML DOI: 10.29328/journal.jccm.1001179 Cite this Article Read Full Article PDF


Peripartum cardiomyopathy; PPCM; Acute severe pancreatitis; Transthoracic echocardiography; Puerperium; Heart failure; Pregnancy; LV systolic dysfunction; Reduced ejection fraction; Intensive care unit


  1. Davis MB, Arany Z, McNamara DM, Goland S, Elkayam U. Peripartum Cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020 Jan 21;75(2):207-221. doi: 10.1016/j.jacc.2019.11.014. PMID: 31948651.
  2. Demakis JG, Rahimtoola SH, Sutton GC, Meadows WR, Szanto PB, Tobin JR, Gunnar RM. Natural course of peripartum cardiomyopathy. Circulation. 1971 Dec;44(6):1053-61. doi: 10.1161/01.cir.44.6.1053. PMID: 4256828.
  3. Pearson GD, Veille JC, Rahimtoola S, Hsia J, Oakley CM, Hosenpud JD, Ansari A, Baughman KL. Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review. JAMA. 2000 Mar 1;283(9):1183-8. doi: 10.1001/jama.283.9.1183. PMID: 10703781.
  4. Bauersachs J, König T, van der Meer P, Petrie MC, Hilfiker-Kleiner D, Mbakwem A, Hamdan R, Jackson AM, Forsyth P, de Boer RA, Mueller C, Lyon AR, Lund LH, Piepoli MF, Heymans S, Chioncel O, Anker SD, Ponikowski P, Seferovic PM, Johnson MR, Mebazaa A, Sliwa K. Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail. 2019 Jul;21(7):827-843. doi: 10.1002/ejhf.1493. Epub 2019 Jun 27. PMID: 31243866.
  5. Mielniczuk LM, Williams K, Davis DR, Tang AS, Lemery R, Green MS, Gollob MH, Haddad H, Birnie DH. Frequency of peripartum cardiomyopathy. Am J Cardiol. 2006 Jun 15;97(12):1765-8. doi: 10.1016/j.amjcard.2006.01.039. Epub 2006 Apr 21. PMID: 16765131.
  6. Brar SS, Khan SS, Sandhu GK, Jorgensen MB, Parikh N, Hsu JW, Shen AY. Incidence, mortality, and racial differences in peripartum cardiomyopathy. Am J Cardiol. 2007 Jul 15;100(2):302-4. doi: 10.1016/j.amjcard.2007.02.092. Epub 2007 Jun 6. PMID: 17631087.
  7. Gentry MB, Dias JK, Luis A, Patel R, Thornton J, Reed GL. African-American women have a higher risk for developing peripartum cardiomyopathy. J Am Coll Cardiol. 2010 Feb 16;55(7):654-9. doi: 10.1016/j.jacc.2009.09.043. PMID: 20170791; PMCID: PMC3814012.
  8. Harper MA, Meyer RE, Berg CJ. Peripartum cardiomyopathy: population-based birth prevalence and 7-year mortality. Obstet Gynecol. 2012 Nov;120(5):1013-9. doi: 10.1097/aog.0b013e31826e46a1. PMID: 23090517.
  9. Irizarry OC, Levine LD, Lewey J, Boyer T, Riis V, Elovitz MA, Arany Z. Comparison of Clinical Characteristics and Outcomes of Peripartum Cardiomyopathy Between African American and Non-African American Women. JAMA Cardiol. 2017 Nov 1;2(11):1256-1260. doi: 10.1001/jamacardio.2017.3574. PMID: 29049825; PMCID: PMC5815055.
  10. Elkayam U, Akhter MW, Singh H, Khan S, Bitar F, Hameed A, Shotan A. Pregnancy-associated cardiomyopathy: clinical characteristics and a comparison between early and late presentation. Circulation. 2005 Apr 26;111(16):2050-5. doi: 10.1161/01.CIR.0000162478.36652.7E. PMID: 15851613.
  11. Chirillo F, Baritussio A, Cucchini U, Toniolli E, Polo A, Iavernaro A. Challenges in the diagnosis of peripartum cardiomyopathy: a case series. Eur Heart J Case Rep. 2021 Feb 16;5(2):ytab001. doi: 10.1093/ehjcr/ytab001. PMID: 33738415; PMCID: PMC7954255.
  12. Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, Regitz-Zagrosek V, Schaufelberger M, Tavazzi L, van Veldhuisen DJ, Watkins H, Shah AJ, Seferovic PM, Elkayam U, Pankuweit S, Papp Z, Mouquet F, McMurray JJ; Heart Failure Association of the European Society of Cardiology Working Group on Peripartum Cardiomyopathy. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail. 2010 Aug;12(8):767-78. doi: 10.1093/eurjhf/hfq120. PMID: 20675664.
  13. Elkayam U, Tummala PP, Rao K, Akhter MW, Karaalp IS, Wani OR, Hameed A, Gviazda I, Shotan A. Maternal and fetal outcomes of subsequent pregnancies in women with peripartum cardiomyopathy. N Engl J Med. 2001 May 24;344(21):1567-71. doi: 10.1056/NEJM200105243442101. Erratum in: N Engl J Med 2001 Aug 16;345(7):552. PMID: 11372007.
  14. Sutton MS, Cole P, Plappert M, Saltzman D, Goldhaber S. Effects of subsequent pregnancy on left ventricular function in peripartum cardiomyopathy. Am Heart J. 1991 Jun;121(6 Pt 1):1776-8. doi: 10.1016/0002-8703(91)90025-d. PMID: 2035390.
  15. Codsi E, Rose CH, Blauwet LA. Subsequent Pregnancy Outcomes in Patients With Peripartum Cardiomyopathy. Obstet Gynecol. 2018 Feb;131(2):322-327. doi: 10.1097/AOG.0000000000002439. PMID: 29324614.
  16. Sliwa K, Mebazaa A, Hilfiker-Kleiner D, Petrie MC, Maggioni AP, Laroche C, Regitz-Zagrosek V, Schaufelberger M, Tavazzi L, van der Meer P, Roos-Hesselink JW, Seferovic P, van Spandonck-Zwarts K, Mbakwem A, Böhm M, Mouquet F, Pieske B, Hall R, Ponikowski P, Bauersachs J. Clinical characteristics of patients from the worldwide registry on peripartum cardiomyopathy (PPCM): EURObservational Research Programme in conjunction with the Heart Failure Association of the European Society of Cardiology Study Group on PPCM. Eur J Heart Fail. 2017 Sep;19(9):1131-1141. doi: 10.1002/ejhf.780. Epub 2017 Mar 8. PMID: 28271625.


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