Peripartum cardiomyopathy
Background
- Uncommon cause of heart failure
- Incidence: 1:968 to 1:4000 in the United States[1]
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
- ECG
- CXR
- CBC & LFTs, screen for thrombocytopenia or transaminitis that can be found with severe pre-eclampsia
- Chemistry
- TSH
- TTE, bedside can show LV dilation and LV systolic dysfunction
- BNP
Diagnosis
4 criteria needed to meet definition:[2]
- 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 in pregnancy)
- If pregnant, fetal monitoring can assist in evaluating uterine perfusion
- Avoid phenylephrine and norepinephrine if pregnant due to increased vasoconstriction of uterine arteries leading to placental insufficiency
- Consider anticoagulation for EF <30% during pregnancy and within 2-3 months following delivery (avoid warfarin and DAOCs)
- Beta-blockers improve survival and are safe in pregnancy, but should not be given in acute decompensated heart failure
Disposition
- Admit
Prognosis[3]
- Mortality rate up to 10%
- High risk of recurrence in subsequent pregnancies
- Many patients recover within 3 to 6 months of disease onset
See Also
References
- ↑ Sliwa K et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail. 2010;12(8):767. PMID: 20675664
- ↑ 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.
- ↑ Bhattacharyya A et Al. Peripartum Cardiomyopathy: A Review. Tex Heart Inst J. 2012; 39(1): 8–16.