Background: Acute post-partum dyspnea configures an obstetric challenge with multiple differential diagnosis. Case Presentation: We present a case of a previous healthy woman with preeclampsia who developed severe dyspnea 30 hours after delivery. She complained of cough, orthopnea, and bilateral lower extremities oedema. She denied headaches, blurry vision, nausea, vomiting, fever or chills. Auscultation revealed a diastolic murmur, and was compatible with pulmonary oedema. A timely bedside echocardiogram showed moderate dilated left atrium with severe mitral insufficiency suggestive of an unknown rheumatic disease. She was managed with noninvasive ventilation, loop diuretics, vasodilators, thromboprophylaxis, head-end elevation, and fluid restriction with progressive improving. Conclusions: Previously silent cardiac diseases constitute intriguing causes of post-partum dyspnea with pulmonary oedema. A timely and multidisciplinary approach is required to manage these situations.

Background Acute post-partum dyspnea configures an obstetric challenge with multiple differential diagnosis. Case presentation We present a case of a previous healthy woman with preeclampsia who developed severe dyspnea 30 h after delivery. She complained of cough, orthopnea, and bilateral lower extremities oedema. She denied headaches, blurry vision, nausea, vomiting, fever or chills. Auscultation revealed a diastolic murmur, and was compatible with pulmonary oedema. A timely bedside echocardiogram showed moderate dilated left atrium with severe mitral insufficiency suggestive of an unknown rheumatic disease. She was managed with noninvasive ventilation, loop diuretics, vasodilators, thromboprophylaxis, head-end elevation, and fluid restriction with progressive improving. Conclusions Hemodynamic changes in pregnant patients with previously silent cardiac disease may pose a challenge and cause post-partum dyspnea. This scenario requires a timely and multidisciplinary approach.

In conclusion, this case draws our attention due to its rarity and attention is drawn to the difficulty of preoperative diagnosis and treatment.