Two Babies, One Failing Heart: A Case of Peripartum Cardiomyopathy after Twin Delivery

Abstract

Background: Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening cause of heart failure occurring toward the end of pregnancy or in the months following delivery. Early recognition is essential to optimize outcomes. Case Presentation: We report the case of a 43-year-old woman, G4P3, with no known cardiovascular history, who presented 23 days postpartum after a twin pregnancy complicated by preeclampsia. She developed paroxysmal nocturnal dyspnea, orthopnea, and neurological symptoms including headache, blurred vision, and tinnitus. Physical examination revealed stable hemodynamics. ECG demonstrated complete left bundle branch block with secondary repolarization abnormalities. Laboratory evaluation showed a high level of prolactin without any inflammatory, metabolic, or infectious abnormalities. Transthoracic echocardiography revealed a dilated, non-hypertrophied left ventricle with global severe hypokinesia, spontaneous contrast, and a markedly reduced LVEF of 25–30%. Cardiac MRI excluded alternative etiologies and showed no late gadolinium enhancement. Conclusion: This case illustrates a typical yet severe manifestation of PPCM in the early postpartum period, occurring after a twin pregnancy—a circumstance that likely amplified the patient’s hemodynamic burden and precipitated ventricular dysfunction. It highlights the need for clinicians to remain vigilant when managing high-risk pregnancies, where early recognition of PPCM can meaningfully alter the clinical course.