Peripartum cardiomyopathy

Background

• Disease earlier than last month of pregnancy is likely the same process of HF
• Prognosis
  • Mortality rate up to 10%
  • High risk of relapse in subsequent pregnancies
  • Many patients recover within 3 to 6 months of disease onset

Evaluation

• Presentation similar to typical CHF
• 4 criteria needed to meet definition for PPCM:
  • Development of heart failure in last month of pregnancy or within 5mo of delivery
  • Absence of an identifiable cause for the heart failure
  • Absence of recognizable heart disease prior to the last month of pregnancy
  • LV systolic dysfunction, such as LVEF < 45%

Differential Diagnosis

• Respiratory tract infection
• PE
• MI
• Postpartum fluid overload

Cardiomyopathy

• Dilated cardiomyopathy
• Hypertrophic cardiomyopathy
• Restrictive cardiomyopathy
• Peripartum cardiomyopathy
• Takotsubo cardiomyopathy
• Arrhythmogenic right ventricular dysplasia

3rd Trimester/Postpartum Emergencies

• Amniotic fluid embolus
• Chorioamnionitis
• Acute fatty liver of pregnancy
• Eclampsia
• HELLP syndrome
• Mastitis
• Peripartum cardiomyopathy
• Postpartum endometritis
• Postpartum headache
• Postpartum hemorrhage
• Preeclampsia
• Retained products of conception
• Uterine rupture

Work-Up

1. ECG
2. CXR
3. CBC
4. Chemistry
5. TSH
6. TTE

Management

• Treat like usual heart failure (except avoid nitroprusside and ACEI)

See Also

• Post-Partum Emergencies
• Cardiomyopathy (Main)

References

• Elkayam U et al. Pregnancy-associated cardiomyopathy: clinical characteristics and a comparison between early and late presentation. Circulation. 2005 Apr 26; 111(16): 2050-5.