title: All that wheezes is not asthma: A cautionary case study of shortness of breath in pregnancy.
abstract: BACKGROUND
  Shortness of breath is a common physiological pregnancy presentation, secondary to both hormonal and mechanical effects. Its pathological causes are common (asthma exacerbation or infection); new-onset cardiac pathology is rarely considered.
  
  
  METHODS
  JC, a 39-year old G4P2T1, presented at 34 weeks' gestation with shortness of breath unrelieved by salbutamol. History included asthma, poly-drug abuse and smoking. Initial presentation was consistent with asthma exacerbation and she was treated as such. There was deterioration of symptoms and on re-examination raised jugular venous pressure was noted with bibasal lung crepitations and cardiac systolic murmur. Echocardiogram showed severe cardiomyopathy (left ventricular ejection fraction 20%). JC was commenced on diuretics, digoxin and fluid restricted. Labour was induced at 35 weeks' gestation, with birth of a healthy female infant (BW 2475 g) by elective assisted vaginal delivery. Cardiac function improved in subsequent weeks, confirming peripartum cardiomyopathy.
  
  
  CONCLUSIONS
  Peripartum cardiomyopathy affects 1 in 2500-4000 live births. Over 90% of women regain normal cardiac function postpartum with optimal medical management. Peripartum cardiomyopathy presents a diagnostic conundrum as its primary symptoms mimic not only those of normal pregnancy but also a number of other, more common conditions. It is important to consider cardiac causes of shortness of breath initially, and vital to revisit an initial non-cardiac shortness of breath diagnosis if there is no sustained improvement with treatment. In this case, asthma history and initial wheeze on examination impeded correct diagnosis; however, the situation was re-evaluated and correct diagnosis made when the patient's shortness of breath deteriorated. Subsequent multidisciplinary management and birth in an appropriate setting facilitated the best outcome for both mother and baby.
authors: Department of Women's and Children's Health, St George Hospital, Kogarah, NSW, Australia.
authors: Nicla A
authors: NA
authors: Varnier
authors: Department of Women's and Children's Health, St George Hospital, Kogarah, NSW, Australia.
authors: Sarah
authors: S
authors: Chwah
authors: Department of Women's and Children's Health, St George Hospital, Kogarah, NSW, Australia.
authors: Trent
authors: T
authors: Miller
authors: Department of Renal Medicine, St George Hospital, Kogarah, NSW, Australia.
authors: Franziska
authors: F
authors: Pettit
authors: Department of Renal Medicine, St George Hospital, Kogarah, NSW, Australia.
authors: Mark
authors: M
authors: Brown
authors: Department of Cardiology, St George Hospital, Kogarah, NSW, Australia.
authors: David
authors: D
authors: Rees
authors: Department of Women's and Children's Health, St George Hospital, Kogarah, NSW, Australia; School of Women's and Children's Health, UNSW Medicine, Sydney, Australia.
authors: Amanda
authors: A
authors: Henry
keywords: Cardiovascular; complications; general medicine; high-risk pregnancy; intensive care medicine