PERIPARTUM CARDIOMYOPATHY DEVELOPED AFTER DELIVERY AS A RARE CAUSE OF HEART FAILURE: A CASE REPORT
Authors:   Kazan State Medical University, DIMITRIEVA DARYA V. , TRONIN KIRILL D. ,   Kazan State Medical University, ZAKIROVA ELVIRA B. ,   City Clinical Hospital No. 7 named after M.N. Sadykov, Kazan, SLEPUHA ELENA G. ,   City Clinical Hospital No. 7 named after M.N. Sadykov, Kazan, MUKHITOVA ELZA I. ,   City Clinical Hospital No. 7 named after M.N. Sadykov, Kazan, BAZAEVA NATALYA V. ,   City Clinical Hospital No. 7 named after M.N. Sadykov, Kazan, KHAZOVA ELENA V. ,   Kazan State Medical University, BULASHOVA OLGA V. ,   Kazan State Medical University
Published: January 2025

Abstract. Introduction. Peripartum cardiomyopathy is a rare, idiopathic myocardial disease occurring during pregnancy
or within 5 months after delivery and characterized by the decreased contractility of the left ventricular myocardium.
Insufficient awareness of physicians about this rare pathology creates prerequisites for the description of interesting
clinical observations. This article presents a case follow-up (for 5 months) of female patient R. with diagnosed peripartum
cardiomyopathy at the age of 31 years after childbirth. Before and during pregnancy, no risk factors or pathology of
cardiovascular system, or myocardium exposure to toxic substances were identified. Patient R. first sought medical
attention 3 months after her fourth delivery (in total, there were 5 pregnancies and 4 deliveries without pathologies)
and prolonged breastfeeding, symptoms of heart failure appeared and rapidly progressed. Aim. To present a clinical
case of peripartum cardiomyopathy developed in the postpartum period. Materials and Methods. A clinical case of
peripartum cardiomyopathy of patient R. was analzed, who voluntarily signed the informed consent for examination and
permission to anonymously publish personal medical information. Results and Discussion. Peripartum cardiomyopathy
is a diagnosis of exclusion; therefore, an important stage is differential diagnosis with manifestations of pre-eclampsia
and myocarditis. Untimely diagnosis of peripartum cardiomyopathy, in some cases, is due to lack of physicians’
awareness. An important criterion for diagnosing peripartum cardiomyopathy is the absence of any previously diagnosed
cardiovascular diseases; therefore, the first priority is to exclude heart valve defects and dilated cardiomyopathy. In
addition, it is necessary to exclude pregnancy-mediated hemodynamic changes, as well as differential diagnosis with
such conditions as myocarditis, Takotsubo syndrome, pulmonary embolism, acute coronary syndrome, and human
immunodeficiency virus. Conclusions. Thus, the factors contributing to the development of peripartum cardiomyopathy
in patient R. were as follows: Age over 30 years, 4 childbirths, iron deficiency anemia. Three diagnostic criteria have
formed the basis for the diagnosis of peripartum cardiomyopathy: 1) debut of heart failure within 5 months after delivery;
2) no newly diagnosed heart disease more than 1 month before delivery or any other causes of chronic heart failure;
and 3) left ventricular dysfunction according to the findings of echocardioscopy and magnetic resonance imaging with
the ejection fraction decreased down to 13 %.