Patient Diagnosed Initially with Peripartum Cardiomyopathy, Later Rediagnosed with Peripartum Myocardial Infarction: A Case Report

Differentiating peripartum cardiomyopathy (PPCM) from pregnancy-associated myocardial infarction (PAMI) is challenging due to shared risk factors. We report a case of a 35-year-old woman who suffered a seizure and cardiac arrest in the final month of her second pregnancy. Echocardiography showed a normal left ventricular ejection fraction (LVEF). Three days later, she developed heart failure symptoms and a marked reduction in LVEF. After one month of treatment, LVEF nearly normalized, but regional wall motion abnormalities subsequently appeared, prompting coronary angiography, which showed normal coronary arteries. Thus, PPCM was diagnosed. One year later, cardiac magnetic resonance imaging, performed due to her wish for another pregnancy, showed a scar consistent with a previous transmural myocardial infarction. We interpret this as a case of PAMI. Despite medical contraindications, she became pregnant one year after the infarction and delivered via C-section. Five years post-event, there are no signs of heart failure. This case lies in the gray zone of pregnancy-related cardiac complications and highlights the importance of multimodality imaging for thorough structural and functional assessment.