%0 Journal Article
%T An unusual case of peripartum cardiomyopathy manifesting with multiple thrombo-embolic phenomena
%A Uzoma N Ibebuogu
%A John W Thornton
%A Guy L Reed
%J Thrombosis Journal
%D 2007
%I BioMed Central
%R 10.1186/1477-9560-5-18
%X Peripartum cardiomyopathy (PPCM) is a rare form of heart failure of unknown cause with a reported incidence of 1 per 3000 to 1 per 4000 live births. Onset is usually between the last month of pregnancy and up to 5 months postpartum in previously healthy women, with a reported fatality rate of 20%¨C50%. Although viral, autoimmune and idiopathic factors may be contributory, its etiology remains unknown. PPCM usually presents initially with signs and symptoms of heart failure and rarely with thrombo-embolic complications. We report an unusual case of PPCM in a previously healthy woman who presented with an acute abdomen due to multiple thromboemboli.A 24 year old gravida 5 woman with no history of alcohol or drug abuse, and no previous history of cardiovascular disease, presented to the emergency department (ED) 5 months after an uneventful full term spontaneous vaginal delivery followed by tubal ligation. She complained of a severe epigastric and right upper quadrant abdominal pain, nausea and vomiting. Physical examination revealed normal vital signs, epigastric and right upper quadrant tenderness without peritoneal signs. Abdominal ultrasound showed thickened anterior gall bladder wall without stones or sludge and no pericholecystic fluid. Liver enzymes and amylase were within normal limits. She was given analgesics and subsequently discharged from the ED following complete resolution of her symptoms. Three days later she returned with a severe, worsening right upper quadrant and epigatric pain, nausea and shortness of breath. She also complained of left lower extremity and back pains. At this time, her blood pressure was 130/100 mmHg with a heart rate of 100. She had bilaterally decreased air entry on lung examination, intermittent apical third heart sound with a regular rate and rhythm, right upper quadrant and epigastric tenderness, bilateral costovertebral angle tenderness and a negative Murphy's sign. An acute abdominal x-ray series was normal. Chest x-ray (Fig.
%U http://www.thrombosisjournal.com/content/5/1/18