Mild diastolic dysfunction post partum

[beth0277]

Hi...

I gave birth 7 weeks ago and due to some complications my doctors suspected that I had perinatal cardiomyopathy. I was given an echo at 5 days postpartum and it came back normal. I ended up having postpartum pre-eclampsia and my bp shot up very quickly, however it was controlled within the day and has been well controlled ever since. I am now weaning off of Labetalol. I was still worried about my heart so I got another echo at 15 days postpartum. After speaking with my cardiologist, he said that it was normal except for mild diastolic dysfunction, which was also evident on the first echo. He said that since I am young (25) and have never had a history of high bp (aside from the pre-eclampsia), high cholesterol, or diabetes then he said my diastolic dysfunction was most likely just caused by my pregnancy/pre-eclampsia and would return to normal within a few months as long as I controlled my BP. He also said that he did not read the actual echo and was just going by the other cardiologists report and that diastolic dysfunction is often over-diagnosed.

It has now been 7 weeks since I gave birth and I am still slightly worried about my heart. I had a BNP reading of 425 at 5 days postpartum (which my OB said that pregnancy/pre-e can raise this number) and yesterday had it re-drawn and it was down to a 7. Would this signify that my diastolic function is in fact going back to normal as my cardiologist mentioned? I also talked to my cardiologist again to voice my concerns and he said he personally looked at my echo's and did not see the dysfunction and that I had nothing to worry about. I am confused as to how he could see no dysfunction when 2 other doctors reported it. Either way, whether I had it or not, I am just curious if you agree that it should go away and also if you think the lower BNP is a signal that it is returning to normal. If you do not agree with the dr, do you think it will continue to get worse or stay the same?

Thanks so much for your input...

[Lee Kirksey, MD]

Hello
Congratulations on the birth of your child. Perinatal cardiovascular changes are usually reversible and the fact that your BNP is returning to normal suggests your heart is no longer stressed. Your doctors will probably want you to have a repeat echo at some point to establish a baseline. The echo is a test that reveals results along a spectrum from completely normal to the extreme of severely abnormal and all things in between. Interpreting it has some degree of variation especially in someone with reported very mild changes. I would not work to much about the interpretation variation as long as you feel well and the repeat is unremarkable.  You should seek to return to a baseline healthy weight as soon as possible.
Best of luck

[beth0277]

I should add that the day that I had the first echo & bnp reading I was extremely swollen from the pre-e. After the echo I actually lost 7 liters in fluid over 24 hours. I don't know if this could have an effect on my diastolic functioning but I have read that volume overload can so I thought I would mention it.