PERIPARTUM CARDIOMYOPATHY: DIAGNOSIS AND IMPLICATIONS. C.L. Long 1 , R. Deversa 1 ; 1 University of Tennesee College of Medicine-Chattanooga unit, Chattanooga, TN LEARNING OBJECTIVES: 1-Identify theories regarding etiology of peripartum cardiomyopathy. 2-Recognize physical findings of peripartum cardiomyopathy. 3-Recognize the morbidity and mortality associated with peripartum cardiomyopathy. CASE INFORMATION: A 23 year old caucasian female, G 1 P1, who is status post caesarean section two weeks prior presented with increasing shortness of breath. She had elevated JVP, bibasilar crackles, and a S3 gallop. ECG showed no acute changes. CXR revealed cardiomegaly with pulmonary venous congestion. An echocardiogram revealed a dilated left ventricle and an ejection fraction of 15%. Despite appropriate treatment during admission, patient became hypotensive, and went into asystole. Aggressive resuscitation was unsuccessful. DISCUSSION: Peripartum cardiomyopathy is defined as the development of heart failure in the last month of pregnancy or within five months after delivery without any determinable cause and without previous heart disease before the last month of pregnancy. The etiology of peripartum cardiomyopathy is unknown. Some actually question whether this is a distinct disorder or another form of idiopathic cardiomyopathy. Several ideas have been proposed including an immunologic response to the fetus, increased hemodynamic load of pregnancy, nutrition, and hormone response. Several studies have actually shown that these patients have a high incidence of myocarditis, possibly implicating a viral trigger like enterovirus. Signs and symptoms are typical for congestive heart failure. However, these can sometimes be confused with normal pregnancy. Therefore, peripartum cardiomyopathy may not be diagnosed until postpartum. Evaluation would include ECG, chest xray, and an echocardiogram. Cardiac catheterization should be considered in those at risk for atherosclerosis. Endomyocardial biopsy remains controversial. Serum can be tested for bacterial and viral cultures and Coxsackie B virus titers. Therapy consists of digoxin, diuretics, sodium restriction, and afterload-reducing agents. Thromboembolic phenomena are common and anticoagulation should be strongly considered. Cardiac transplantation may be considered as well. The mortality rate ranges from 25 ± 50%. Nearly half of these deaths occur within the first 3 months postpartum. Death is often caused by chronic progressive congestive heart failure, an arrhythmia, or a thromboemolic event. If the patient's heart is to recover, it willusually do so within the first 6 months. If ventricular function does not improve, it is often recommended that the patient not become pregnant again due to the high risk of death.