The story of Shana Greatman Swers is bittersweet. She meets the love of her life through a Jewish dating online service; becomes engaged 8 months later and connects with her friends through the social media network, Facebook.® At 35 years old, Shana becomes pregnant and provides updates to her friends. Her story should have had a happy ending but unfortunately it doesn’t. Shortly after delivering her healthy baby boy, Shana developed heart problems and went back and forth to the hospital. Her ultimate diagnosis was fatal, a condition called peripartum cardiomyopathy or PPCM. The Facebook entries chronicle the trying ordeal of Shana and husband Jeff up until Shana’s funeral.
Peripartum cardiomyopathy is a rare condition of heart failure that affects 1 in 3,000 to 4,000 women in the United States each year and has an extremely poor prognosis. It claimed the life of my grandmother in 1939 five months after giving birth to my youngest aunt. Although it has been recognized since 1849, the clinical condition was not given a name until the 1930’s. The condition does not affect women until their late third trimester or postpartum period. The most common symptoms of heart failure (HF) include shortness of breath with movement or lying down, swelling of the feet and ankles and cough or wheezing with blood-tinged phlegm. PPCM is defined as
- Development of HF in the last month of pregnancy or 5 months postpartum
- Absence of a specific reason for HF
- Absence of heart disease until the last month of pregnancy
- Left ventricular ejection fraction below 45 percent
Women who are at risk for this dreadful disease include
- Women over 30
- Women who have more than one child (Although Shana did not fit this criteria)
- Women of African descent
- A history of pre-eclampsia, eclampsia or postpartum hypertension
- Greater than 4 weeks of the use of medicine to stop preterm labor
The treatment of the disease is similar to treatment for heart failure. Cardiac consultation is paramount for a favorable outcome. If the left ventricular ejection fraction can be improved, the prognosis is usually favorable. In rare cases, heart transplantation is necessary. If the patient survives after PPCM, it is highly recommended that a future pregnancy be avoided.
Every day 2 to 3 women die in childbirth in our country. My personal goal is reduce that number to zero. It is said that the good die young. If that be the case, then Shana was probably a saint on loan from Heaven. Rest in peace, Shana. You led a short but glorious life and we are grateful to your family for sharing some of those sacred moments.