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Peripartum Cardiomyopathy

My Story

Risk factors
Future Pregnancies
My Story

I was diagnosed in July 1997 with a dilated cardiomyopathy, about a week and half after the birth of my twins. I was 33 and had just made it through a difficult pregnancy complicated by preterm labor and pre-eclampsia. For five weeks, I had been on bedrest and the terbutaline pump (aka subcutaneous injection of terbutaline sulfate) for preterm labor. I was hospitalized with too many contractions just shy of my 33rd week. My obstetrician put me on a high dose of magnesium sulfate *plus* the terbutaline to try to stop the contractions. It didn't work. After 14 to 16 hours of both drugs, I was taken off everything when abnormal liver and kidney readings were detected in my blood.

I noticed during my hospital recovery from a C-Section that I needed the bed tilted up quite high in order to sleep and I was coughing a lot. I attributed these symptoms to stress since my twins were 7 weeks premature, and I also was still experiencing signs of pre-eclampsia (swelling of feet and legs, high blood pressure, elevated liver enzymes and abnormal kidney readings). The first night after my release from the hospital, I couldn't sleep because of my coughing and my inability to breathe well lying down. I only was able to get small amounts of sleep by using about six pillows on my bed. I knew something was terribly wrong and thought about waking up my husband to take me back to the hospital. But I really didn't want to go back there. So I toughed it out over the next few nights. Each day, I called my obstetrican's office to ask about these symptoms. My OB was on vacation. Her partner kept telling me the symptoms were from my pre-eclampsia. He told me to take cough medicine. Finally, my OB came back from vacation. A chest X-ray and echocardiogram showed my left ventricle was enlarged and not pumping efficiently. I learned later that the symptoms I experienced were those of congestive heart failure.

I had no family history of cardiomyopathy or heart disease at a young age. I had not been overweight before becoming pregnant, didn't smoke, had always had normal blood pressure and had not drunk alcohol during my pregnancy. Nor had I ever used cocaine. My cardiologist did some research and told me he thought my condition was due to the terbutaline I took for preterm labor and/or my pre-eclampsia. He quoted the chances of developing a heart problem on terbutaline as 1/1,000. I began to do research at a medical library and discovered the likelihood could be much greater than that, especially for women pregnant with twins. For more information about the risks of preterm labor drugs, check out my web page on the subject.

Because I was no longer taking terbutaline and my pre-eclampsia symptoms departed, my cardiologist decided to take a wait-and-see approach and hold off on heart medication. I was expressing milk for my premature twins, and this approach enabled to me to continue expressing for another month. I had two echocardiograms in July 1997. The first showed an ejection fraction of 49 percent; the second showed one of 45 percent. About six months later, in January 1998, I started feeling better. My ejection fraction improved to 53 percent and my left ventricle was no longer enlarged. In March 1999, my ejection fraction had improved to 64 percent. I never ended up taking any heart medications.

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