Peripartum cardiomyopathy
Revision as of 04:59, 2 April 2019 by Rossdonaldson1 (talk | contribs)
Background
- Uncommon cause of heart failure
Clinical Features
- Peripartum with presentation similar to typical CHF
- Usually occurs in last month of pregnancy or first five months postpartum
Differential Diagnosis
Cardiomyopathy
- Dilated cardiomyopathy
- Hypertrophic cardiomyopathy
- Restrictive cardiomyopathy
- Peripartum cardiomyopathy
- Takotsubo cardiomyopathy
- Arrhythmogenic right ventricular dysplasia
3rd Trimester/Postpartum Emergencies
- Acute fatty liver of pregnancy
- Amniotic fluid embolus
- Chorioamnionitis
- Eclampsia
- HELLP syndrome
- Mastitis
- Peripartum cardiomyopathy
- Postpartum endometritis (postpartum PID)
- Postpartum headache
- Postpartum hemorrhage
- Preeclampsia
- Resuscitative hysterotomy
- Retained products of conception
- Septic abortion
- Uterine rupture
Evaluation
Workup
Diagnosis
4 criteria needed to meet definition:[1]
- Development of heart failure in last month of pregnancy or within 5 month postpartum
- No identifiable alternate cause of heart failure
- No pre-existing heart disease
- LV ejection fraction < 45%
Management
- Treat like usual heart failure (except avoid nitroprusside and ACEI)
Disposition
- Admit
Prognosis[2]
- Mortality rate up to 10%
- High risk of recurrence in subsequent pregnancies
- Many patients recover within 3 to 6 months of disease onset