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Learning from errors
Unilateral presentation of postpartum cardiomyopathy misdiagnosed as pneumonia
  1. Ben Hayman Amit1,
  2. Alon Marmor2,
  3. Amer Hussein3
  1. 1Emergency Department, Tel Aviv Medical Center, Tel Aviv, Israel
  2. 2Cardiology Institute, Ziv Medical Center, Safed, Israel
  3. 3Emergency Department, Ziv Medical Center, Safed, Israel
  1. Correspondence to Ben Hayman Amit, dr.ben.amit{at}


A 34-year-old woman presented to the emergency department with severe dyspnoea 10 days following a normal-course caesarean delivery. She had been experiencing shortness of breath throughout the third trimester of pregnancy accompanied by tachycardia (110 bpm); however, her evaluation did not include ECG or chest radiography to elucidate the cause. Following delivery, chest radiography was performed demonstrating predominantly unilateral findings interpreted as pneumonia. ECG revealed T-wave inversion in leads V4–V6, which was unaddressed. Overnight she deteriorated and a chest CT angiography was performed demonstrating heart enlargement and pulmonary oedema. An echocardiogram established a diminished ejection fraction (EF) of 15–20%, suggesting the diagnosis of peripartum cardiomyopathy. She was treated with angiotensin-converting enzyme inhibitors, spirinolactone and furosemide, and was free of symptoms the following month with an EF of 40–45%. Though uncommon, heart failure is a potentially fatal cause of peripartum dyspnoea, often misdiagnosed, meriting further attention.

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  • Competing interests None.

  • Patient consent Obtained.