Multiple Biventricular Intracardiac Thrombi—An Unusual Finding in Peripartum Cardiomyopathy: A Case Report

Peripartum cardiomyopathy (PPCM) is a rare form of heart failure occurring during late pregnancy or within 5 months postpartum, its etiology remaining elusive. While typically characterized by left ventricular dysfunction, it may present with intracardiac thrombi, raising the risk of systemic embolization. Here, we report an unusual case of PPCM featuring biventricular intracardiac thrombi, highlighting the importance of a thorough investigation for potential underlying causes. This is a case of a black African, multiparous woman aged 44 years with an unremarkable past medical history, who presented with symptoms suggestive of acute heart failure 5 months after her last delivery. A 2D Transthoracic Echocardiography showed multiple biventricular intracardiac thrombi, a rare complication of PPCM without a systemic embolic event. Further, laboratory tests for evidence of a hypercoagulable state came out negative. Treatment involved a combination of acute heart failure and anticoagulation followed by optimal medical therapy for chronic heart failure, resulting in improved symptoms for heart failure, cardiac function, and significant thrombi resolution after 8 weeks. Multiple biventricular intracardiac thrombi are an uncommon finding in PPCM, underscoring the importance of vigilant diagnosis and timely management. Although the management of PPCM remains challenging due to limited evidence, an individualized approach to heart failure therapy and anticoagulation can lead to meaningful clinical improvement and favorable outcomes.