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Postnatal pre-cordial pain. Pulmonary embolism or peripartum cardiomyopathy
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  1. B Quinn1,
  2. B Doyle2,
  3. J McInerney1
  1. 1Emergency Department, Mater Misericordiae Hospital, Dublin, Ireland
  2. 2Cardiology Department, Mater Misericordiae Hospital
  1. Correspondence to:
 Mr J J McInerney
 Emergency Department, Mater Misericordiae Hospital, Dublin D7, Ireland; jmcinerneymater.ie

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Patients who attend the emergency department with pre-cordial pain after pregnancy present a diagnostic dilemma. While pulmonary embolism (PE) is a comparatively common cause,1 peripartum cardiomyopathy (PPCM) although rare, should always be considered in the differential diagnosis.2 PPCM is a rare form of congestive heart failure that affects women late in pregnancy or in the early peurperium.3 It is a disorder of unknown aetiology with a high mortality rate approaching 50%.3–5 We report a presentation of a patient with postnatal pre-cordial pain and the clinical findings, which permitted correct diagnosis and treatment.

CASE REPORT

A 36 year old white woman was referred to the emergency department by her general practitioner with a diagnosis of suspected PE. She had had a caesarean section seven days previously, with a three day history of exertional precordial discomfort, dyspnoea on exertion, and right calf swelling. There was no productive cough or haemoptysis. She had no personal or family history of cardiac disease. She smoked five cigarettes a day before becoming pregnant but denied smoking since. She had no history suggestive of a pre-existing heart condition as she had a previous excellent exercise tolerance.

On examination she was pale and anxious with a respiratory rate of …

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