First Documented Case Report of Peripartum Takotsubo Cardiomyopathy in Diyala Province: Clinical Presentation and Follow-Up

Background: Takotsubo Cardiomyopathy (TTC) is a condition that can present like a myocardial infarction, however unlike a myocardial infarction it is reversible. It has been shown to be very rare during the peripartum period with little available literature on the subject. This report will document formally the first case of peripartum Takotsubo cardiomyopathy in Iraq, particularly in the Diyala Province. Case Presentation: A previously healthy 25-year-old mother with one prior uncomplicated delivery and a normal electrocardiogram and echocardiogram(ejection Fraction 68%) underwent an elective Cesarean Section at AlZahra hospital in Diyala. Within 24 hours of delivery there was development of significant dyspnoea and orthopnoea. Echocardiography revealed symptoms of Left Ventricular dilation, moderate mitral regurgitation and akinesia of the midseptal wall. The Ejection fraction was significantly reduced at (38%) however the Echocardiogram also revealed deterioration of left ventricular function. The ECG showed ST Elevation in the septal leads with T-wave inversion in the lateral leads. The elevation of Troponin was measured at 200ng/l, the Pro Brain Natriuretic Peptide was markedly Elevated. CT coronary angiogram excluded significant coronary artery disease. The patient was given standard heart failure therapy and displayed a rapid recovery both clinically and on Echocardiograph. At 6 days postpartum the patient’s Ejection Fraction was back to normal (61%) and the patient was discharged from the hospital in stable condition. Conclusion: This case highlights the importance of including Takotsubo cardiomyopathy in the differential diagnosis of peripartum cardiac dysfunction. The rapid recovery that patients experience with supportive therapy is distinctive for Takotsubo cardiomyopathy compared to peripartum cardiomyopathy. The early identification and appropriate management of Takotsubo cardiomyopathy are essential for the best outcomes for mothers. This case adds to the very limited documentation available for peripartum Takotsubo cardiomyopathy and represents the first case to be documented in our area.