title: Symptoms in women with Peripartum Cardiomyopathy: A mixed method study.
abstract: OBJECTIVE
  Peripartum Cardiomyopathy is a form of cardiac disease often associated with cardiac failure, occurring in late pregnancy or after childbirth. The anatomical and physiological changes in the mother associated with normal pregnancy are profound, and this may result in symptoms and signs that overlap with Peripartum Cardiomyopathy, leading to missed or delayed diagnosis. Women's experiences of Peripartum Cardiomyopathy symptoms remain poorly studied. The aim of this study was to explore and describe women's experiences of symptoms in Peripartum Cardiomyopathy.
  
  
  METHODS
  A triangulation of methods with individual interviews and data from medical records.
  
  
  METHODS
  Mothers with Peripartum Cardiomyopathy diagnosis were recruited from Western Sweden as a part of research project.
  
  
  METHODS
  19 women were interviewed and medical records were reviewed by authors.
  
  
  METHODS
  All interview transcripts were analysed using qualitative inductive content analysis to identify key themes.
  
  
  RESULTS
  The main theme, meaning of onset and occurrence of symptoms is captured in the metaphor: being caught in a spider web, comprising subthemes, invasion of the body by experienced symptoms and feeling of helplessness. Symptoms related to Peripartum Cardiomyopathy started for 17 women during pregnancy and in two post partum and time from symptoms to diagnosis varied between three and 190 days (median 40). The physical symptoms were:shortness of breath, excessive fatigue and swelling, bloatedness, nausea, palpitation, coughing, chest tightness, bodily pain, headache, fever, tremor, dizziness, syncope, restless and tingly body and reduced urine output. Emotional symptoms were: fear, anxiety, feelings of panic, and thoughts of impending death.
  
  
  CONCLUSIONS
  Symptoms of Peripartum Cardiomyopathy were debilitating, exhausting and frightening for the women interviewed in this study. Health care professionals responsible for the antenatal care, especially midwives, need skills to identify initial symptoms of Peripartum Cardiomyopathy for early referral and treatment by a specialist. In order to give optimal care more research is needed to show how to improve midwives' knowledge of Peripartum Cardiomyopathy.
authors.affiliation: Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden. Electronic address: Harshida.patel@gu.se.
authors.forename: Harshida
authors.initials: H
authors.lastname: Patel
authors.affiliation: Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden. Electronic address: marie.berg@fhs.gu.se.
authors.forename: Marie
authors.initials: M
authors.lastname: Berg
authors.affiliation: Aga Khan University Hospital, Nairobi, Kenya; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden. Electronic address: anders.barasa@gu.se.
authors.forename: Anders
authors.initials: A
authors.lastname: Barasa
authors.affiliation: Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; School of Nursing and Midwifery, Trinity College Dublin, Ireland. Electronic address: cbegley@tcd.ie.
authors.forename: Cecily
authors.initials: C
authors.lastname: Begley
authors.affiliation: Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden. Electronic address: maria.schaufelberger@gu.se.
authors.forename: Maria
authors.initials: M
authors.lastname: Schaufelberger
mesh_terms: D000328:Adult; D009202:Cardiomyopathies / Q000150:complications / Q000523:psychology*; D057210:Delayed Diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D008880:Midwifery; D024802:Nurse's Role; D058725:Peripartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000523:psychology*; D011369:Professional-Patient Relations; D036301:Qualitative Research; D011795:Surveys and Questionnaires
keywords: Content analysis; Heart disease; Peripartum Cardiomyopathy; Pregnancy; Qualitative methods; Symptoms