Peripartum Cardiomyopathy Presenting with Repetitive Monomorphic Ventricular Tachycardia G ¨ OKMEN GEMICI, HAKAN TEZCAN, ALI SERDAR FAK, and AHMET OKTAY From the Marmara University School of Medicine, Cardiology Department, Istanbul, Turkey GEMICI, G., ET AL.: Peripartum Cardiomyopathy with Repetitive Ventricular Tachycardia. A 30-year- old asymptomatic pregnant woman at 38 weeks’ gestation was noticed to have repetitive monomorphic ventricular tachycardia. A dilated left ventricle with moderately reduced systolic function was found on echocardiographic examination. To the best of our knowledge, a case of peripartum cardiomyopathy presenting with repetitive monomorphic ventricular tachycardia has not been previously reported. (PACE 2004; 27:557–558) peripartum cardiomyopathy, ventricular tachycardia Case Report A 30-year-old pregnant woman at 38 weeks’ gestation was admitted to the coronary care unit because she was noticed to have ventricular tachycardia just before cesarean section. She was asymptomatic and she neither had a previous car- diac disease nor a positive family history for heart disease. On admission her blood pressure was 110/70 mmHg, and heart rate was 110 beats/min. The rest of the physical examination was within normal limits. ECG at the coronary care unit re- vealed sinus rhythm with repetitive monomor- phic ventricular tachycardia at a rate of 150 beats/ min (Fig. 1). A dilated left ventricle with an end diastolic diameter of 70 mm and moderately re- duced systolic function was found on echocardio- graphic examination. Ventricular arrhythmia was suppressed by lidocaine infusion, and the 12-lead ECG was found to be normal. A successful ce- sarean section was then performed. A healthy in- fant was delivered. Repetitive monomorphic ven- tricular tachycardia recurred soon after stopping the lidocaine infusion, and oral sotalol 160 mg daily was initiated. However, after a total dose of 160 mg of sotalol, the patient developed poly- morphic ventricular tachycardia which degener- ated into ventricular fibrillation. Sinus rhythm was maintained by immediate defibrillation and so- talol was replaced by metoprolol 100 mg daily. The patient remained asymptomatic under meto- prolol and lisinopril treatment, although repetitive monomorphic ventricular tachycardia did not re- solve. Follow-up at six months revealed repetitive ventricular runs on ECG, and a left ventricle with an end-diastolic diameter of 59 mm and moder- Address for reprints: G ¨ okmen Gemici, M.D., Cardiology Depart- ment, Marmara University School of Medicine, Tophanelioglu Cad. No: 13/15, 34660 Altunizade, Istanbul/Turkey. Fax: +90 216 3276035; e-mail: gokmen@dr.com Received June 13, 2003; revised September 2, 2003; accepted November 23, 2003. ately reduced systolic function on echocardiogra- phy. Discussion Peripartum cardiomyopathy is a rare life- threatening cardiomyopathy of unknown cause that occurs in the peripartum period in previously healthy women. The clinical presentation is the development of new onset heart failure. The in- cidence is approximately 1 per 3,000 to 1 per 4,000 live births. 1 Because most of the women in their last month of a normal pregnancy have mild dyspnea and pedal edema, peripartum car- diomyopathy may be unrecognized, leading to un- derestimation of the incidence. Ventricular tachy- cardia recognized on routine ECG preceding the cesarean section helped us to reach the diagno- sis of peripartum cardiomyopathy in our asymp- tomatic patient. To the best of our knowledge, a case of peripartum cardiomyopathy presenting with repetitive monomorphic ventricular tachy- cardia has not been previously reported. Although treatment with metoprolol and lisinopril failed to suppress the repetitive mono- morphic ventricular tachycardia, the patient was discharged on these drugs. Regarding the poten- tially reversible course of the disease and the lack of evidence on the nonpharmacological treatment of ventricular arrhythmias in patients with peri- partum cardiomyopathy, radiofrequency catheter ablation or ICD implantation was not considered as therapeutic options at the present time. The long-term outcome of peripartum cardiomyopa- thy mainly depends on the recovery of the left ventricular function. Approximately half of the patients recover completely. 1,2 Hence, ventricular arrhythmias in the present patient can be expected to resolve as left ventricular function recovers. Patients whose left ventricular dysfunction does not resolve within six months following delivery are known to have an extremely high mortality rate. 1-3 PACE, Vol. 27 April 2004 557