Young, pregnant – and a deadly heart condition

by Carolyn Thomas

Martha is one of those young women who believes she was born to have babies.  “I’ve always been a nurturing person  – and bossy to boot!” she laughs.  “And isn’t that what mothers are made of?”  So she and hubby Joseph were thrilled when, at the age of 26, she became pregnant with their first baby. 

“In the last month of my pregnancy, I began feeling bloated, tired, had trouble breathing and also had what seemed the worst flu of my life. I told my obstetrician about my symptoms, but she said that it was ‘normal’, that I was ‘over-reacting’, and to stop worrying. When a bad cough got worse and I just couldn’t sleep, I called my doctor and she told me to take some cough syrup, and to stop worrying.”

One evening, just two weeks before her due date, Martha had dinner  and later watched Desperate Housewives on TV.  Right afterwards, she noticed a ‘bloody show’ during a trip to the bathroom.  Alarmed, she headed to the hospital, where the unthinkable happened.  “When they hooked me up to the usual monitors, the nurse couldn’t find my daughter’s heartbeat.”

An ultrasound confirmed the devastating truth – her baby was dead. The obstetrician told her:

“I have nothing good to tell you. She’s gone. I don’t know how or why, but she’s gone. And what’s worse, you need to calm down because your own health is in danger now.”

With no time to grieve over the loss of their baby girl, Michelle, and critically ill herself, Martha spent the next two hours and one Code Blue in the O.R. before being finally stabilized.  “I woke up in the ICU, intubated, realizing that this hadn’t all been a horrible nightmare after all,” she says.

So what went wrong? Martha had developed a heart condition during her pregnancy called Peripartum Cardiomyopathy or PPCM.  Her doctors confirmed later that she had been minutes away from death.

Cardiomyopathy is an abnormality of the heart muscle (from the root words ‘cardio’ meaning heart, ‘myo’ (muscle), and ‘pathy’ (disease). The heart becomes enlarged and its pumping action severely reduced.  Cardiomyopathy can be viral or hereditary, or due to a number of complex factors affecting the body’s autoimmune system that are still being investigated by researchers.

But there is one form of cardiomyopathy that affects only women, as Martha tragically learned. Peripartum cardiomyopathy occurs in the last trimester of pregnancy or within a few months of giving birth. The heart muscle can’t contract forcefully enough to pump adequate amounts of blood for the needs of the body’s vital organs.

PPCM is rare, occurring in only about one in 4,000 pregnancies in North America (but as high as one in 300 pregnancies in Haiti, for example). About one third of PPCM patients are, like Martha, young women with their first pregnancy. About half of PPCM patients experience complete recovery of heart function, and some are even able to safely tolerate future pregnancies. Unfortunately, some women never recover, and go on to develop chronic congestive heart failure with a catastrophic mortality rate of 85%.

Symptoms of PPCM include:

• difficulty breathing while lying flat
• shortness of breath on exertion
• pitting edema (swelling) especially in feet/andles
• unusual fatigue
• cough
• frequent night-time urination
• excessive weight gain during the last month of pregnancy (two to four or more pounds per week)
• palpitations (sensation of racing heart rate, skipping beats, long pauses between beats, or fluttering),
• chest pain

Martha, despite the unimaginable grief of losing her baby, is one of the lucky young PPCM survivors.  

“My heart healed in three months! After a year of medications, strict diet and exercise, and life-saving counselling therapy, I was able to begin ‘talking baby’ again. In March of 2009, my cardiologist and I decided it was time to get off my heart meds. In April, my follow-up echocardiogram showed that my heart function is still going strong!  No more birth control now, and today I had my last cardiologist’s appointment – until my first trimester after I become pregnant again!”

“My advice for all pregnant women and new moms now would be: follow your instincts and listen to your body! You are the only one who can feel what is going on inside you.  

“Don’t let any doctor tell you, without sufficient testing, that you’re overreacting. It’s just too high a price to pay.”

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Find out more about Peripartum Cardiomyopathy.

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NEWS UPDATE:  Martha and Joseph had their second baby, a healthy little boy, in September 2010!  Congratulations to all!