Peripartum Cardiomyopathy and Takotsubo Cardiomyopathy: Rare Contributors to Cardiac Causes of Maternal Mortality.

Peripartum cardiomyopathy (PPCM) and takotsubo cardiomyopathy (TCM) are cardiac conditions that can occur in the peripartum period. They have distinct characteristics and incidence rates; although rare, both contribute to the second leading cause of all-cause maternal mortality in the state of Missouri. PPCM can lead to heart failure, and TCM can cause acute arrhythmias leading to sudden cardiac death in otherwise healthy individuals. Our patient developed PPCM and TCM, which led to myocardial infarction, resulting in anoxic brain injury at 10 months postpartum. This case presentation demonstrates the need to consider pregnancy-related conditions up to 12 months postpartum. We postulate that the cardiomyopathies could have presented as early as five to eight weeks postpartum. Had our patient received screening for cardiac disease, resulting in earlier diagnosis and treatment, she may still be alive today. Increased surveillance and suspicion of cardiac diseases are crucial to reducing early and late postpartum mortality. Our patient presented to the ER for a headache three days before developing cardiac arrest. Our recommendation would be to screen any asymptomatic woman up to 12 months postpartum with an electrocardiogram and brain natriuretic peptide and compare the results to the baseline, if available. If any results from the screening tests are abnormal, clinicians should further investigate with troponin levels and echocardiography. We recommended reporting this case to the Missouri Maternal Mortality Review Committee and a hospital autopsy be performed for further investigation and contribute to our understanding of high maternal deaths in the state.