What Is Postpartum Cardiomyopathy?

Written by Alicia Racelis, PhD, WebMD Editorial Contributor
Medically Reviewed by Traci C. Johnson, MD on July 19, 2025
9 min read

Postpartum cardiomyopathy is a type of heart failure that weakens your heart one month before or up to five months after your delivery. Because your heart problems happen around childbirth, it's also called peripartum cardiomyopathy (PPCM). Your lower left heart chamber (ventricle) grows larger and pumps less blood to your organs.

Between 1 in 1000 and 1 in 4000 women get postpartum cardiomyopathy each year in the U.S. But Black women are three times more likely to have this condition. The diagnosis for PPCM is often delayed because it's often mistaken for signs of late pregnancy.

Many people with PPCM can recover with treatment. But rarely, the condition can become life-threatening. Learn more about symptoms, causes, and treatments to lower your risk for postpartum cardiomyopathy complications.

No one is sure exactly what causes postpartum cardiomyopathy. But many experts think unbalanced hormones, medical conditions, inflammation, and genetics lead to PPCM.

Hormone and nutritional imbalances. Hormone changes can happen during pregnancy. Prolactin is needed for milk production. If it's out of balance, the hormone can damage heart cells. Some studies also show not having enough selenium can lead to PPCM. But it's still unclear.

High blood pressure problems. High blood pressure conditions, such as preeclampsia, can affect heart health in pregnancy. And the conditions may harm vascular endothelial growth factor (VEGF) signaling. Without this type of signal, your blood vessel health can worsen.

Inflammation and your immune system. Changes during pregnancy can cause more stress on your heart cells --- it's called oxidative stress. And your immune system goes through changes, too. The walls of your heart chambers can become larger with inflammation. 

This can cause less blood to pump out of your heart chamber during each contraction. The stress of delivery may also play a role.

Genetic factors. Cardiomyopathy is a heart muscle disease. About 15 to 20 in 100 people with peripartum cardiomyopathy may have inherited gene changes causing cardiomyopathy. And the stress of pregnancy may lead to your heart muscle getting weaker.

But more studies are needed to link PPCM to inflammation, your immune system, and genetics. If you have a history of heart disease, tell your OB/GYN.

Many factors can raise your risk for postpartum cardiomyopathy. Knowing you're at higher risk can help you and your OB/GYN safely plan for your pregnancy.

Before you get pregnant, you have a higher risk for PPCM if you:

  • Are 35 years or older
  • Are Black
  • Are American Indian or Alaskan Native
  • Have medical conditions such as obesity, diabetes, infections, or autoimmune conditions
  • Have a history of substance or alcohol abuse

Once you're pregnant, you may have a higher PPCM risk if you:

  • Are pregnant for the first time
  • Don't get enough nutrients through your diet or prenatal vitamins
  • Are pregnant with multiple babies
  • Have a history of PPCM
  • Have high blood pressure (hypertension) during pregnancy, called preeclampsia
  • Take more than four weeks of beta-adrenergic agonist medicine (such as terbutaline) to stop premature labor

You can also have a higher risk after having four or more children. But most people develop postpartum cardiomyopathy after the first or second pregnancy.

Are there special considerations for women of color?

Some studies show that women of color have a higher risk for PPCM. And women of color diagnosed with PPCM may also have more serious heart damage.

Women of color with PPCM:

  • Are more likely to get serious complications from PPCM
  • Are diagnosed at a younger age
  • Are not diagnosed in the postpartum period until their PPCM is more serious (advanced)
  • Have a lower chance for recovery, causing a higher risk for sudden cardiac death

If you have a history of stroke, high blood pressure, or heart disease, tell your OB/GYN, especially if you're Black. Your OB/GYN can check, catch any signs, and treat your PPCM early.

Not everyone has the same symptoms for postpartum cardiomyopathy. It's common to think you're just having signs of late pregnancy. 

With PPCM, you may get: 

  • Shortness of breath, especially when lying down or during your sleep (often waking you up)
  • Cough
  • Swelling in your lower legs, ankles, and feet
  • Fast heart rate (tachycardia)
  • Extreme tiredness
  • Blood pressure drops (suddenly drops when you stand)
  • Swollen neck veins
  • Trouble exercising or being active
  • A third heart sound, a murmur, or signs of a larger heart (your doctor thinks your heart pulse is displaced)
  • Signs of a blood clot in your lung (chest pain, coughing up blood, or bluish skin)

Many of the PPCM symptoms commonly happen in the later stages of pregnancy, too. Remember, with postpartum cardiomyopathy, your symptoms are typically worse. And they may worsen over time. If you have any PPCM symptoms, call your doctor. Early treatment can help you get well faster.

When to call the doctor

Postpartum cardiomyopathy can be a serious, life-threatening condition. Certain symptoms can mean you need medical care right away. 

Call 911 or get immediate medical care if you have:

  • Chest pain
  • Fast heartbeat (palpitations)
  • Fainting
  • Any new symptoms

Your doctor will do an EKG, echocardiogram (echo), and blood test to diagnose your postpartum cardiomyopathy. They'll also listen to your heart and lungs. Your doctor checks to see if your lungs have any fluid in them. Then, they'll do a physical exam.

Your doctor will check your heart health using:

  • Echocardiogram, an ultrasound of your heart
  • EKG to record the electrical signals from your heart
  • Blood tests for B-type natriuretic peptides (BNP) or N-terminal pro-BNP (NT-proBNP)

A heart health test can measure your heart's ability to pump — called the left ventricle ejection fraction (LVEF). It tests the amount of blood your ventricle pumps out with each contraction. The LVEF tells your doctor how serious your cardiomyopathy has gotten. Normally, your LVEF is about 60%, but with PPCM, it is usually lower than 45%.

If your doctor thinks you have fluid in your lungs, you may also get a chest X-ray and viral and bacterial cultures. And if your doctor needs a detailed image of your heart, they may order an MRI.

Can postpartum cardiomyopathy be genetic?

Yes, about 10 to 20 in 100 women with PPCM have a gene causing cardiomyopathy. This means it's inherited, and it runs in your family. Your doctor may run a special test on your DNA. They'll ask you about your family history of cardiomyopathy, sudden death, or PPCM.

Your treatment will depend on when your PPCM starts — if you're pregnant or not. Your doctor treats PPCM by keeping extra fluid out of your lungs and helping your heart get better. There are many types of medicines that can help. Some are safer if you're pregnant or breastfeeding. 

PPCM during pregnancy and breastfeeding

Your doctor may give you:

  • Diuretics. These are also called water pills and help your body get rid of extra fluid. 
  • Beta-blockers. These cause the heart to pump more slowly so it has time to get well. 
  • Hydralazine (Apresoline) plus nitrates. This combinationhelps relax your blood vessels to lower your blood pressure.

If your symptoms continue, your doctor may also try:

  • Digitalis (Digoxin). This medicine comes from the foxglove plant. It helps strengthen your heart's ability to pump. It's been used for more than 200 years to treat heart failure.
  • Inotropes. These help your heart muscle pump stronger.

After delivery and breastfeeding

Your doctor may treat you with:

  • Angiotensin-converting enzyme (ACE) inhibitors. These medications help your heart work more efficiently.  
  • Anticoagulants. These are medications that keep your blood from clotting. People with PPCM are more likely to form blood clots. 
  • Mineralocorticoid receptor antagonists (MRAs). These help your kidneys get rid of extra fluids.
  • Sodium-glucose cotransporter-2 (SGLT2) inhibitors. These medicines keep your kidneys from absorbing glucose to lower blood pressure and cardiovascular risk.

Devices to treat PPCM

With treatment, up to 70% of people with PPCM recover after 3-12 months. But sometimes, symptoms can worsen. Your doctor may suggest an implantable device to help avoid sudden cardiac death. These devices include:

  • Implantable cardioverter-defibrillator is a small device placed in your chest to detect an abnormal heartbeat. It sends an electric shock to your heart to correct your heartbeat.
  • Pacemaker is a small device to resync your heart rhythm. The device sends electric signals to your lower heart chambers to cause them to contract correctly.

Most women with postpartum cardiomyopathy get back some or all of their heart health. Closely follow-up with your doctor. Everyone heals differently. Some people recover after two weeks, but others may partly recover after six months or more. 

The state of your PPCM — how serious your condition is — doesn't seem to impact your recovery. In fact, you can recover completely even with serious symptoms and a low ejection fraction.

Can I get pregnant again after postpartum cardiomyopathy?

Yes. If you want to have more children, talk about the risks with your doctor. Depending on your recovery, you may have a higher risk for PPCM if you get pregnant again.

If you've fully recovered, your PPCM risk may be lower than those who haven't but higher than the general population. In one small study, 28 women who fully recovered from PPCM got pregnant again. During their next pregnancy, only six women had an LVEF of 21% with heart failure (HF) symptoms. And no sudden cardiac deaths occurred.

But if you continue to have a lower heart health, another pregnancy can lead to a higher risk for serious complications. That's because pregnancy can put extra strain on your heart and your heart failure can worsen. But not everyone has the same outcome.

In a small study, 14 women with PPCM did not fully get better during their first pregnancy. During their next pregnancy:

  • Eight women had worsening heart failure.
  • One woman had sudden cardiac death.
  • Seven women continued to get better and fully recovered by 30 months of pregnancy.

If you're thinking about another pregnancy, talk to a doctor who specializes in high-risk pregnancies and your cardiologist. They can help you review your risks and answer any questions before you get pregnant again.

Postpartum cardiomyopathy is a rare type of heart failure that happens before or right after childbirth. It's also called peripartum cardiomyopathy (PPCM) and weakens your lower left heart chamber (ventricle). Because the symptoms can mimic signs of late pregnancy, you may not be diagnosed until later. If you have life-threatening symptoms, such as chest pain, palpitations, or fainting, get medical help right away. Talk to your doctor about treatment for PPCM to get better faster.

Is postpartum cardiomyopathy reversible?

With treatment, many people can fully get well from postpartum cardiomyopathy. And early treatment can help avoid life-threatening complications. But about 4% may need a heart transplant, and about 9% may have sudden cardiac death.

Is postpartum cardiomyopathy hereditary​?

About 15%-20% of women with PPCM can have an inherited gene that causes cardiomyopathy. And pregnancy can trigger cardiomyopathy. If you have a family history for heart disease, especially cardiomyopathy, tell your OB/GYN right away. Your doctor can test you for hereditary genes that raise your risk for getting postpartum cardiomyopathy.

Can postpartum cardiomyopathy cause sudden death?

Yes, postpartum cardiomyopathy (PPCM) can sometimes cause sudden cardiac death. Because some cases before 2003 were misclassified, it's still unclear how often it happens. A recent study showed that PPCM can cause death in 1 in 100,000 deliveries. But this rate is six times higher in Black women. 

Talk to your doctor about treatments if you're at higher risk for PPCM. Your doctor can suggest an implantable cardioverter-defibrillator or pacemaker. These devices can send a small shock to correct your heartbeat and lower your risk for sudden cardiac death.