Medical Mystery: New mom has cough, fatigue

Pregnancy causes a multitude of changes in the body, so when a patient experienced puzzling symptoms after the birth of her first child, she tried to wait it out.

She was fatigued, like many new parents. She was retaining water and had swollen feet, a common occurrence during pregnancy.

But she was also coughing and waking at night with shortness of breath.

The patient was in her late 20s and had worked full-time before going out on maternity leave. After delivery, she was busy caring for her new addition and tried to chalk up the symptoms to the birth. After all, her body had been through a lot.

When symptoms persisted, she visited her primary care provider, who zeroed in on the coughing and prescribed a medication for suspected bronchitis. But the meds didn't work. Her baby was now 2 months old, and the new mother needed to find out what was wrong.

During this second visit, the doctor performed an electrocardiogram (EKG). Seeing the results, the doctor quickly transferred her to the emergency room.

When the patient arrived at the hospital, her ejection fraction - how well her heart was pumping - was below 10 percent, indicating heart failure.

We diagnosed peripartum cardiomyopathy, muscle damage to the heart that can occur during the last month of pregnancy or within five months after the birth. It affects as many as 1 in 2,500 pregnant women in the U.S.

There is a lot we don't know about why and how this happens, although recent research published in the New England Journal of Medicine points to a possible genetic mutation as a potential cause among some women.

Known risk factors include obesity, high blood pressure, diabetes, prior exposure to toxins (such as tobacco, alcohol, cocaine), a personal history of heart inflammation (myocarditis), having twins or previous births, and being of African descent.

Our patient stayed in the hospital for a week. We treated her aggressively to relieve her symptoms and start the process of healing and recovery. Fortunately, she did not need a heart transplant.

We diagnosed and treated her sleep apnea, tweaked her diet, and taught her an exercise program so she could continue a heart-healthy regimen at home.

Between the medication and her lifestyle changes, her heart has recovered well, and we continue monitoring her as an outpatient.

Paul J. Mather is the Lubert Family Professor of Cardiology, Sidney Kimmel Medical College at Thomas Jefferson University, and director of the Advanced Heart Failure and Cardiac Transplant Center at the Jefferson Heart Institute.

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