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Question 7#

A 34-year-old woman is referred by an OB-GYN colleague for the onset of fatigue and dyspnea on exertion 1 month after her second vaginal delivery. Physical examination reveals a laterally displaced PMI, elevated jugular venous pressure, and pitting lower extremity edema. Echocardio-gram shows systolic dysfunction with an ejection fraction of 30%. Which statement most accurately describes her condition? 

A. This disease may occur unexpectedly years after pregnancy and delivery
B. About half of similar patients will recover completely
C. The condition is idiosyncratic; the risk of recurrence with a future pregnancy is no greater than average
D. This condition will require a different therapeutic approach than the typical dilated cardiomyopathy
E. This condition will require endomyocardial biopsy for diagnosis

Correct Answer is B

Comment:

 Although peripartum (or postpartum) cardiomyopathy may occur during the last trimester of pregnancy or within 6 months of delivery, it most commonly develops in the month before or after delivery. The most common demographics are multiparity, African American race, and age greater than 30. About half of patients will recover completely, with most of the rest improving, although the mortality rate is 10% to 20%. These women should avoid future pregnancies due to the risk of recurrence. Treatment is as for other dilated cardiomyopathies, except that ACE inhibitors are contraindicated in pregnancy. Diagnosis can typically be made without invasive testing.