Left Ventricular Recovery Following Bromocriptine Initiation at Different Stages of Peripartum Cardiomyopathy: A Report of Two Cases.

Peripartum cardiomyopathy (PPCM) is a rare yet potentially life-threatening form of heart failure that occurs during late pregnancy or within the months following delivery. Bromocriptine, which suppresses prolactin secretion, has emerged as a promising adjunctive therapy for PPCM; however, the optimal timing of its initiation remains uncertain. We describe two patients with PPCM who received bromocriptine at different stages of the disease course. The first patient was a 30-year-old woman who presented 33 days after delivery with cardiogenic shock, a left ventricular ejection fraction (LVEF) of 12%, and a left ventricular thrombus. Despite treatment with intra-aortic balloon pumping, venoarterial extracorporeal membrane oxygenation, anticoagulation, and guideline-directed medical therapy, recovery of left ventricular function plateaued. Bromocriptine was initiated on hospital day 44, after which LVEF increased from 38% to 53% within seven days and subsequently recovered to 60%. The second patient was a 35-year-old woman who developed acute heart failure nine days after delivery with an LVEF of 28%. Because left ventricular function remained markedly impaired despite standard heart failure therapy, bromocriptine was initiated on hospital day seven. Her LVEF improved to 39% by hospital day 15 and ultimately recovered to 61%. These cases demonstrate a temporal association between bromocriptine initiation and subsequent improvement in left ventricular systolic function at different stages of the clinical course of PPCM.