Asri Nordini, Abdul-Razak Suraya, Mokhtar Mohd Fazrul, Ibrahim Khairul Shafiq, Abdul Kadir Roqiah Fatmawati
Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Kampus Sungai Buloh, Sungai Buloh, Selangor 47000, Malaysia.
Cardiovascular Advancement and Research Excellence (CARE) Institute, UiTM, Kampus Sungai Buloh, Sungai Buloh, Selangor 47000, Malaysia.
Eur Heart J Case Rep. 2025 Jul 1;9(7):ytaf306. doi: 10.1093/ehjcr/ytaf306. eCollection 2025 Jul.
Peripartum cardiomyopathy (PPCM) is a rare but potentially fatal cause of heart failure that occurs towards the end of pregnancy or within the first 5 months postpartum, in the absence of other identifiable cause of cardiac dysfunction. It is characterized by left ventricular systolic impairment, with an ejection fraction (LVEF) typically ≤ 45%. While most cases are diagnosed shortly after delivery, delayed presentations can occur, leading to significant diagnostic challenges and complicate treatment.
We report a case of a 40-year-old multiparous (Para 3) woman, who developed progressive dyspnoea beginning 2 months after delivery. Despite two earlier medical care visits, her symptoms were initially misdiagnosed. She represented with overt symptoms of heart failure 1 month later. Investigations encompassing transthoracic echocardiography, cardiac magnetic resonance imaging, coronary angiography, and NT-proBNP confirmed PPCM with a severely reduced LVEF of 16%. She was promptly initiated on guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF), including an angiotensin receptor-neprilysin inhibitor and a sodium-glucose cotransporter-2 inhibitor. At 3-month follow-up, her symptoms had resolved, and LVEF recovered to 56%.
This case highlights the diagnostic challenge of delayed-onset PPCM and reinforces the importance of maintaining high suspicion in postpartum women presenting with persistent dyspnoea. Early initiation of GDMT for HFrEF can lead to full functional recovery. Routine postpartum surveillance should include careful assessment for cardiopulmonary symptoms, even in the absence of overt risk factors, to prevent delays in diagnosis and management.
围产期心肌病（PPCM）是一种罕见但可能致命的心力衰竭病因，发生在妊娠晚期或产后前5个月内，且无其他可识别的心脏功能障碍病因。其特征为左心室收缩功能受损，射血分数（LVEF）通常≤45%。虽然大多数病例在分娩后不久被诊断出来，但也可能出现延迟表现，这会带来重大的诊断挑战并使治疗复杂化。
我们报告一例40岁经产妇（孕3产），产后2个月开始出现进行性呼吸困难。尽管此前有过两次就医经历，但她的症状最初被误诊。1个月后她出现明显的心力衰竭症状。经胸超声心动图、心脏磁共振成像、冠状动脉造影和NT - 脑钠肽检测等检查确诊为PPCM，LVEF严重降低至16%。她立即开始接受针对射血分数降低的心力衰竭（HFrEF）的指南指导药物治疗（GDMT），包括使用血管紧张素受体脑啡肽酶抑制剂和钠 - 葡萄糖协同转运蛋白2抑制剂。在3个月的随访中，她的症状得到缓解，LVEF恢复到56%。
该病例凸显了迟发性PPCM的诊断挑战，并强调了对出现持续性呼吸困难的产后女性保持高度怀疑的重要性。早期启动针对HFrEF的GDMT可实现完全功能恢复。常规产后监测应包括仔细评估心肺症状，即使没有明显的危险因素，以防止诊断和管理的延误。
