Incorporating Cardio-Obstetrics into Advanced Heart Failure Training

Abstract

I recently took care of a young woman in her 30s in my fellows’ clinic with a newly diagnosed nonischemic cardiomyopathy with mild dilation and a left ventricular ejection fraction of 20%. She had presented in the middle of the coronavirus disease 2019 pandemic with decompensated heart failure of unclear etiology. She had 3 young and healthy children at home, with her last pregnancy a few years earlier. She tolerated her prior pregnancies well, with the exception of gestational hypertension that evolved into chronic hypertension. At each visit, in addition to uptitrating her medical therapy, we discussed contraceptive strategies. She was planning for intrauterine device implantation. Before she could undergo intrauterine device insertion, she became pregnant. By this time, we celebrated how her left ventricular ejection fraction had improved, although it was not entirely normal.