# Diagnostic and Therapeutic Challenges Between Peripartum and Influenza-Induced Inflammatory Cardiomyopathy—A Case Report and Literature Review

## TL;DR

This paper presents a case where a woman's heart condition after pregnancy was diagnosed as peripartum cardiomyopathy, highlighting the challenges in distinguishing it from influenza-induced heart disease.

## Contribution

The paper contributes a detailed case report and literature review on the diagnostic and therapeutic challenges between peripartum and influenza-induced cardiomyopathy.

## Key findings

- A 34-year-old woman with twin pregnancy developed heart failure postpartum, initially suspected to be due to myocardial injury.
- Cardiac MRI confirmed peripartum cardiomyopathy without myocardial inflammation, despite elevated inflammatory markers.
- Persistent arrhythmias seven months postpartum necessitated ablation, emphasizing the need for long-term monitoring in such cases.

## Abstract

Objectives: Peripartum cardiomyopathy (PPCM) is a life-threatening cause of heart failure in late pregnancy or postpartum, often difficult to distinguish from other types of cardiomyopathies, such as influenza-induced inflammatory cardiomyopathy (ICM). This case report highlights the diagnostic challenges of differentiating PPCM from ICM and the management of this condition. Methods: A retrospective case analysis was conducted based on medical records from a tertiary centre in Warsaw, Poland, with a follow-up via phone consultations. A literature review was performed using PubMed, Scopus, and Google Scholar, incorporating relevant European Society of Cardiology guidelines. Results: A 34-year-old woman with a twin pregnancy at 36 + 5 weeks underwent a caesarean section and later experienced a syncopal episode. Elevated cardiac biomarkers and inflammatory markers suggested myocardial injury. Echocardiography showed reduced left ventricular function, raising concerns for PPCM or ICM. Cardiac magnetic resonance revealed left ventricular dysfunction without myocardial inflammation, supporting a PPCM diagnosis. Despite LVEF recovery to 65%, a Holter ECG at seven months postpartum showed persistent arrhythmias, necessitating referral for ablation. Conclusions: This case emphasizes the need for a thorough diagnostic approach to differentiate PPCM from conditions like ICM. Long-term monitoring, pre-conception counselling, and preventive strategies, such as influenza vaccination, are crucial for managing PPCM and preventing future complications.