Left Hemiplegia: An Unusual Presentation of Peripartum Cardiomyopathy (PPCM)

Abstract

PPCM is a rare form of heart failure of unknown cause with a reported incidence of 1 per 4,000 live births. Onset is usually between the last month of pregnancy and up to fifth month postpartum in previously healthy women, with a reported fatality rate of 20–25 %. Risk factors for PPCM include multiparity, older maternal age, black color, preeclampsia and twin pregnancies. Its aetiology remains unknown though viral, autoimmune and idiopathic factors may be contributory. 75 % cases present first month postpartum which suggests an autoimmune cause rather than the pregnancy exacerbating a pre-existing cardiomyopathy. PPCM usually presents initially with signs and symptoms of heart failure and rarely with thromboembolic complications. Left ventricle mural thrombus common after acute myocardial infarction but rare in PPCM. The management of PPCM is similar to that of any other forms of dilated cardiomyopathy. True incidence of thromboembolism in PPCM is not known which needs further research. We report an unusual case of PPCM in a previously healthy woman who presented with features of heart failure and left hemiplegia due to thromboembolism.