Peripartum Cardiomyopathy Due to Gestational Hypertension and Tocolytic Therapy

Main Article Content

Ana Chelikikj
Silvana Jovanova
Elena Grueva-Nastevska
Elma Kandic
Ile Kuzmanoski
Oliver Bushljetikj
Zhan Zimbakov


BACKGROUND: Peripartum cardiomyopathy (PPCM) is a rare and sometimes fatal systolic heart failure that affects women during late pregnancy or the early postpartum period. The risk factors contributing to this condition are advanced maternal age, multiparity, administration of tocolytic agents, underlying cardiac disease, iatrogenic volume overload, preeclampsia, and hypertension. In patients with gestational hypertension (GH) and other risk factors, close monitoring is mandatory during pregnancy as well as in the postpartum period.

CASE REPORT: A 38-year-old patient previously treated for endometriosis, infertility, and GH was transferred from the clinic of gynecology due to diagnosed congestive heart failure. 5 days before admission, she gave birth to her first child. Before delivery, she was treated with tocolytic therapy. She received methyldopa due to GH which was abruptly discontinued after her delivery. Echocardiography on admission revealed moderately reduced left ventricular (LV) systolic function with an ejection fraction (EF) of 37% with dilated left ventricle (LV) and pulmonary artery hypertension secondary to LV failure. During hospitalization, the patient was with signs of volume overload, but with a good response on parenteral diuretic therapy. She was additionally treated with guideline-recommended heart failure therapy. The controlled echocardiography showed improvement of LV function with an EF of 42%.

CONCLUSION: PPCM is a rare condition with high morbidity and mortality. An LVEF <30%, marked LV dilatation, LV end-diastolic diameter >6.0 cm, and RV involvement are associated with adverse outcomes. Although delivery of the fetus and the placenta triggers the resolution of symptoms and recovery to the nonpregnant state of various organisms, the contrary happens with blood pressure. Its peak time is 3–6 days after delivery. Hypertension medication must not be immediately terminated. Prolonged tocolytic therapy is a risk factor for PPCM due to causing decreased baroreflex sensitivity. Patients with risk factors should be closely monitored for eventual cardiac complications.


Download data is not yet available.

Article Details

How to Cite
Chelikikj A, Jovanova S, Grueva-Nastevska E, Kandic E, Kuzmanoski I, Bushljetikj O, Zimbakov Z. Peripartum Cardiomyopathy Due to Gestational Hypertension and Tocolytic Therapy. SEE J Cardiol [Internet]. 2022 Oct. 21 [cited 2024 Apr. 23];3(1):18-20. Available from:
Cardiovascular Imaging


Lampert MB, Hibbard J, Weinert L, Briller J, Lindheimer M, Lang RM. Peripartum heart failure associated with prolonged tocolytic therapy. Am J Obstet Gynecol. 1993;168(2):493-5. PMid:8438916 DOI:

Haas DM, Caldwell DM, Kirkpatrick P, McIntosh JJ, Welton NJ. Tocolytic therapy for preterm delivery: Systematic review and network meta-analysis. BMJ. 2012;345:e6226. PMid:23048010. DOI:

Brar SS, Khan SS, Sandhu GK, Jorgensen MB, Parikh N, Hsu JW, et al. Incidence, mortality, and racial differences in peripartum cardiomyopathy. Am J Cardiol. 2007;100(2):302-4. PMid:17631087 DOI:

Dayoub EJ, Datwani H, Lewey J, Groeneveld PW. One- year cardiovascular outcomes in patients with peripartum cardiomyopathy. J Card Fail. 2018;24(10):711-5. PMid:30194024 DOI:

Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy: The task force for the management of cardiovascular diseases during pregnancy of the European society of cardiology (ESC). Eur Heart J. 2018;39(34):3165-41. DOI:

Li PC, Chang HR, Kao SP. Peripartum cardiomyopathy and acute heart failure associated with prolonged tocolytic therapy in pregnancy: A case report. Medicine (Baltimore). 2021;100(34):e27080. PMid:34449509 DOI:

Most read articles by the same author(s)