Peripartum cardiomyopathy

Background

  • Disease earlier than last month of pregnancy is likely the same process of HF
  • Prognosis[1]
    • 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

Postpartum Emergencies

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

References

  1. Bhattacharyya A et Al. Peripartum Cardiomyopathy: A Review. Tex Heart Inst J. 2012; 39(1): 8–16.
  • 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.