Maternal Health

Heart Issues Around Birth (Peripartum Cardiomyopathy)

Medically reviewed by Dr. Lisa Okafor, MD, FACOG · Board-Certified OB-GYN

Content reviewed against published ACOG, NIH, March of Dimes guidelines

Editorial policy

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Your health matters just as much as your baby's. If you are dealing with heart issues around birth (peripartum cardiomyopathy), here is what you need to know.

The short answer

Peripartum cardiomyopathy (PPCM) is a rare but serious form of heart failure that can develop in the last month of pregnancy or up to 5 months after delivery. It occurs in approximately 1 in 1,000-4,000 pregnancies. Early recognition and treatment are critical, as most people recover with proper medical care.

Key takeaways

  • Peripartum cardiomyopathy (PPCM) is a rare but serious form of heart failure that can develop in the last month of pregnancy or up to 5 months after delivery. It occurs in approximately 1 in 1,000-4,000 pregnancies. Early recognition and treatment are critical, as most people recover with proper medical care.
  • Usually normal when: Mild shortness of breath with exertion in late pregnancy
  • Call your doctor if: Severe shortness of breath, especially when lying down or at rest
“About 1 in 8 women experience symptoms of postpartum depression. If you have symptoms of depression that last longer than 2 weeks, tell your health care provider.”
— Depression During and After Pregnancy, Centers for Disease Control and Prevention (CDC)

Parents everywhere have the same worry. You are doing the right thing by looking into it.

What Parents Should Know

According to ACOG, NIH, March of Dimes guidelines, peripartum cardiomyopathy (PPCM) is a rare but serious form of heart failure that can develop in the last month of pregnancy or up to 5 months after delivery. It occurs in approximately 1 in 1,000-4,000 pregnancies. Early recognition and treatment are critical, as most people recover with proper medical care. At Third trimester, pPCM typically presents in the last month of pregnancy. Symptoms include shortness of breath (beyond normal pregnancy breathlessness), persistent cough, swelling in the legs and feet, rapid weight gain from fluid retention, and palpitations. Because these symptoms overlap with normal pregnancy, PPCM can be missed. If breathlessness is severe, progressive, or occurs while lying flat, seek evaluation. It is generally considered normal when mild shortness of breath with exertion in late pregnancy. However, you should contact your pediatrician promptly if severe shortness of breath, especially when lying down or at rest.

Sources: [1], [2], [3]

Normal vs. Concerning

Usually Normal
Worth Discussing
Mild shortness of breath with exertion in late pregnancy
Severe shortness of breath, especially when lying down or at rest
Mild ankle swelling that improves with elevation
Chest pain with breathing difficulty
Occasional palpitations lasting seconds
Persistent rapid heartbeat with dizziness or fainting

By Age

What to expect by age

Third trimester

PPCM typically presents in the last month of pregnancy. Symptoms include shortness of breath (beyond normal pregnancy breathlessness), persistent cough, swelling in the legs and feet, rapid weight gain from fluid retention, and palpitations. Because these symptoms overlap with normal pregnancy, PPCM can be missed. If breathlessness is severe, progressive, or occurs while lying flat, seek evaluation.

Postpartum

PPCM most commonly presents in the first month after delivery. Symptoms include extreme fatigue, inability to lie flat without breathing difficulty, persistent cough, swelling, and rapid heartbeat. Risk factors include age over 30, multiple pregnancies, African American descent, and preeclampsia history. With treatment (heart failure medications), about half of people fully recover heart function.

What to Tell Your Pediatrician

  • Describe when you first noticed heart issues around birth (peripartum cardiomyopathy) and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if shortness of breath that is worsening or more severe than expected for your stage of pregnancy.
  • Mention if swelling that is rapid or does not improve with rest.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

What Should You Do?

When to take action

Probably normal when...
  • Mild shortness of breath with exertion in late pregnancy
  • Mild ankle swelling that improves with elevation
  • Occasional palpitations lasting seconds
Mention at your next visit when...
  • Shortness of breath that is worsening or more severe than expected for your stage of pregnancy
  • Swelling that is rapid or does not improve with rest
  • Heart palpitations that are frequent or prolonged
Act now when...
  • Severe shortness of breath, especially when lying down or at rest
  • Chest pain with breathing difficulty
  • Persistent rapid heartbeat with dizziness or fainting
  • Coughing up frothy or pink-tinged sputum

What You Can Do at Home

  • Keep track of when you notice heart issues around birth (peripartum cardiomyopathy) — noting the time of day, duration, and any triggers can help your pediatrician.
  • Remember that mild shortness of breath with exertion in late pregnancy — this is generally within the range of normal.
  • At Third trimester, focus on observation rather than intervention unless your pediatrician advises otherwise.
  • Prioritize your own rest and nutrition. Accept help when offered, and do not hesitate to reach out to your healthcare provider.
  • While monitoring at home, seek immediate care if severe shortness of breath, especially when lying down or at rest.

Heart Problems After Birth (Postpartum Cardiomyopathy)

Postpartum cardiomyopathy (PPCM) is a rare but serious form of heart failure that develops in the last month of pregnancy or up to 5 months after delivery. It occurs in approximately 1 in 1,000-4,000 deliveries. Symptoms include severe shortness of breath, persistent swelling, rapid heartbeat, and extreme fatigue beyond normal postpartum tiredness. Early diagnosis and treatment are crucial - most people respond well to heart failure medications.

Breathing Difficulty in Pregnancy

Shortness of breath affects up to 75% of pregnant people. It is caused by hormonal changes (progesterone increases respiratory drive), increased oxygen demand, and the growing uterus pushing the diaphragm upward. While usually normal, sudden or severe breathlessness should be evaluated promptly.

Guide

Postpartum Recovery Guide

Week-by-week postpartum recovery timeline and warning signs.

Guide

When to Call the Doctor

General guide on when to call the pediatrician, visit urgent care, or go to the ER.

Frequently asked questions

Is heart issues around birth (peripartum cardiomyopathy) normal?
Peripartum cardiomyopathy (PPCM) is a rare but serious form of heart failure that can develop in the last month of pregnancy or up to 5 months after delivery. It occurs in approximately 1 in 1,000-4,000 pregnancies. Early recognition and treatment are critical, as most people recover with proper medical care.
When should I call the doctor about heart issues around birth (peripartum cardiomyopathy)?
Severe shortness of breath, especially when lying down or at rest Chest pain with breathing difficulty Persistent rapid heartbeat with dizziness or fainting
When is heart issues around birth (peripartum cardiomyopathy) normal?
Mild shortness of breath with exertion in late pregnancy Mild ankle swelling that improves with elevation Occasional palpitations lasting seconds
What causes heart issues around birth (peripartum cardiomyopathy)?
Peripartum cardiomyopathy (PPCM) is a rare but serious form of heart failure that can develop in the last month of pregnancy or up to 5 months after delivery. It occurs in approximately 1 in 1,000-4,000 pregnancies. Early recognition and treatment are critical, as most people recover with proper medical care. Common explanations include: Mild shortness of breath with exertion in late pregnancy. Mild ankle swelling that improves with elevation.
What should I mention to my pediatrician about heart issues around birth (peripartum cardiomyopathy)?
You should mention heart issues around birth (peripartum cardiomyopathy) at your next visit if: Shortness of breath that is worsening or more severe than expected for your stage of pregnancy. Swelling that is rapid or does not improve with rest. Heart palpitations that are frequent or prolonged.
Is heart issues around birth (peripartum cardiomyopathy) normal at Third trimester?
PPCM typically presents in the last month of pregnancy. Symptoms include shortness of breath (beyond normal pregnancy breathlessness), persistent cough, swelling in the legs and feet, rapid weight gain from fluid retention, and palpitations. Because these symptoms overlap with normal pregnancy, PPCM can be missed. If breathlessness is severe, progressive, or occurs while lying flat, seek evaluation.
Is heart issues around birth (peripartum cardiomyopathy) normal at Postpartum?
PPCM most commonly presents in the first month after delivery. Symptoms include extreme fatigue, inability to lie flat without breathing difficulty, persistent cough, swelling, and rapid heartbeat. Risk factors include age over 30, multiple pregnancies, African American descent, and preeclampsia history. With treatment (heart failure medications), about half of people fully recover heart function.
Should I go to the ER for heart issues around birth (peripartum cardiomyopathy)?
Seek emergency care if severe shortness of breath, especially when lying down or at rest, or if chest pain with breathing difficulty. When in doubt, call your pediatrician's after-hours line for guidance.
Does heart issues around birth (peripartum cardiomyopathy) go away on its own?
In many cases, heart issues around birth (peripartum cardiomyopathy) resolves on its own, especially when mild shortness of breath with exertion in late pregnancy.
ACOGNIHMARCH OF DIMES

References

  1. [1]American College of Obstetricians and Gynecologists. Pregnancy and Heart Disease. ACOG Practice Bulletin, 2019. ACOG
  2. [2]National Library of Medicine. Peripartum Cardiomyopathy. StatPearls, 2023. NIH
  3. [3]March of Dimes. Heart Conditions and Pregnancy. March of Dimes, 2023. March of Dimes

Doctor Visit Checklist

Bring this checklist to your next pediatrician visit to discuss Heart Issues Around Birth (Peripartum Cardiomyopathy).

Things to mention

  • Describe when you first noticed heart issues around birth (peripartum cardiomyopathy) and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if shortness of breath that is worsening or more severe than expected for your stage of pregnancy.
  • Mention if swelling that is rapid or does not improve with rest.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

Observations to share

  • Shortness of breath that is worsening or more severe than expected for your stage of pregnancy
  • Swelling that is rapid or does not improve with rest
  • Heart palpitations that are frequent or prolonged

Urgent signs to report immediately

  • Severe shortness of breath, especially when lying down or at rest
  • Chest pain with breathing difficulty
  • Persistent rapid heartbeat with dizziness or fainting

My notes

From ismybabyalright.com — free, evidence-based baby health guides

All content follows our editorial policy and is reviewed against published clinical guidelines.

2,705 evidence-based guides6 authoritative medical sources5 medical advisory board members

Related Resources

Feeding & Pumping GuideEar Infection TriagePregnancy TrackerEmergency ContactsBaby Tracker

Bottom line

Most cases of heart issues around birth (peripartum cardiomyopathy) are normal. Talk to your pediatrician if severe shortness of breath, especially when lying down or at rest.

Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.

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Heart Problems After Birth (Postpartum Cardiomyopathy)

Postpartum cardiomyopathy (PPCM) is a rare but serious form of heart failure that develops in the last month of pregnancy or up to 5 months after delivery. It occurs in approximately 1 in 1,000-4,000 deliveries. Symptoms include severe shortness of breath, persistent swelling, rapid heartbeat, and extreme fatigue beyond normal postpartum tiredness. Early diagnosis and treatment are crucial - most people respond well to heart failure medications.

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