Peripartum cardiomyopathy presenting during caesarean section

A woman in her 30s underwent elective caesarean delivery under spinal anaesthesia. Within minutes of delivery, she developed respiratory distress and shock with hypoxaemia. Chest radiography showed symmetrical, predominantly basal alveolar opacities. CT pulmonary angiography demonstrated a small subsegmental right lower lobe pulmonary embolus with bilateral ground-glass change. Point-of-care echocardiography revealed left ventricular systolic dysfunction (left ventricular ejection fraction ~35-40%) with regional hypokinesis and no right ventricular strain; natriuretic peptide and troponin were markedly elevated. Peripartum cardiomyopathy was diagnosed. She received oxygen, vasopressors and diuretics, and-once haemostasis was secure-staged escalation to therapeutic anticoagulation for the subsegmental embolus. Guideline-directed heart failure therapy was initiated and up-titrated. She improved and was discharged with a cardiology follow-up. This case highlights the need to consider peripartum cardiomyopathy in postpartum collapse despite an identified pulmonary embolus and emphasises early echocardiography, biomarkers and multidisciplinary management.