Four months after an unremarkable vaginal delivery, a previously healthy 34-year-old G1P1 develops fatigue, dyspnea on minimal exertion, and paroxysmal nocturnal dyspnea. She is no longer breastfeeding. Physical examination reveals a fatigued appearing woman, with normal heart sounds and bibasilar crackles in her lungs. She has no evidence of lower extremity edema, calf tenderness, or ascites. Echocardiogram shows global systolic dysfunction without hypertrophy; her ejection fraction is 40%.
Which of the following statements regarding her condition is correct?
A. Peripartum cardiomyopathy may occur unexpectedly years after pregnancy and deliveryBy definition, peripartum cardiomyopathy is cardiac dilatation and dysfunction of unexplained cause occurring during the last trimester of pregnancy or within 6 months of delivery. Half of patients will completely recover normal cardiac size and function. However, further pregnancies in women with persistent left ventricular dysfunction frequently produce increasing myocardial damage and increased mortality, and patients should be counseled to avoid future pregnancies. Treatment is the same as for other types of dilated cardiomyopathy and includes salt restriction, angiotensin-converting enzyme inhibitors, beta-blockers, diuretics, and/or digitalis for symptomatic treatment. Intravenous immunoglobulin therapy has shown some benefit in small studies, but has not been established as first-line therapy.