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Iowa mom delivers healthy baby while battling life-threatening heart failure
Everyone thought Ronda Smith would end her fourth pregnancy just like the first three—in routine fashion with her smiling and cuddling a tiny newborn.
It wasn't to be.
In fact, Smith's pregnancy foreshadowed a dangerous encounter with peripartum cardiomyopathy, a rare, life-threatening type of heart failure experienced during or after pregnancy. The condition took her to death's door and—thanks to expert heart care at both Iowa Methodist Medical Center in Des Moines and University of Iowa Hospitals and Clinics in Iowa City—back again.
It all began routinely enough. Other than a relatively minor heart murmur that had been diagnosed 10 years earlier, Smith was thought to be in excellent health for her pregnancy. Because of problems with swelling and breathing, she was scheduled to be induced to labor on Sept. 15, 2005, at Iowa Methodist, near her hometown of Waukee.
"I remember them putting on an oxygen mask and that's all," she says. "I woke up seven days later in the intensive care unit, unaware of what had happened."
During that turbulent week, Smith nearly died but was revived when doctors re-started her heart with a defibrillator. She also received a heart catheterization after her emergency delivery of a healthy baby girl by cesarean section.
Still, Smith was so sick that she not only didn't see her baby daughter at that time, but family members had to name the girl for her (they chose Molly).
"My oldest daughter (Jill) had to become my legal guardian," Smith says.
Smith's cardiologist at Methodist—Jonathan Fudge, MD, a graduate of the UI Roy J. and Lucille A. Carver College of Medicine—decided that Smith's best hope for survival was to be transferred to the heart failure experts at UI Hospitals and Clinics.
She arrived by helicopter in cardiogenic shock and cardiac arrest. Even before her arrival, a team of UI Heart and Vascular Center specialists began considering the options, which included a ventricular assist device or even a heart transplant.
"Women with peripartum cardiomyopathy can go in several directions," says heart failure specialist Barry Cabuay, MD. "Some women remain stable for long periods, some deteriorate gradually, and some deteriorate rapidly and may be candidates for heart transplants."
Under skillful guidance, however, invasive surgery and transplantation were avoided. Instead, Cabuay managed her heart condition using a complex mix of heart medications. In addition, Brian Olshansky, MD, director of cardiac electrophysiology, implanted a bi-ventricular pacemaker-defibrillator that improves heart function and will jump-start her heart should it unexpectedly stop beating.
The outcome was remarkable. Smith's heart function has increased considerably and she has resumed her life as an active, caring mother to four children: Molly, now aged one; Mallory, 11; Hillary, 16, and Jill, 19.
Smith's gratitude runs deep. "I can honestly say I feel absolutely fantastic and I owe it all to you and the great team you work with!" she told Cabuay.
For more information about UI Heart and Vascular Center's heart failure services, patients and families should call UI Health Access and ask for the cardiomyopathy treatment program; call the program directly at 319-356-1028; or e-mail Carolyn Laxson, RN, at carolyn-laxson@uiowa.edu.
For consultation or referral, physicians should contact UI Consult.
Peripartum cardiomyopathy
- Rare
- Unpredictable
- Most common after age 30
- 25 to 50% fatal
- Usually reversible if correct actions are taken
Symptoms
Women who are currently or recently pregnant with the following symptoms may be developing cardiomyopathy:
- Chest pain
- Palpitations
- Faintness
- Other new or unexplained symptoms
—Michael Sondergard
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