Cardiac disease in pregnancy and peripartum cardiomyopathy: Difference between revisions
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Peripartum cardiomyopathy ''([[PPCM]])'' is a form of [[dilated cardiomyopathy]] that is defined as a deterioration in cardiac function presenting between the last month of gestation and up to five months post-partum. | Peripartum cardiomyopathy ''([[PPCM]])'' is a form of [[dilated cardiomyopathy]] that is defined as a deterioration in cardiac function presenting between the last month of gestation and up to five months post-partum. | ||
The etiology of postpartum cardiomyopathy is unknown. | The etiology of postpartum cardiomyopathy is unknown. Reported prevalence of postpartum cardiomyopathy in United States is estimated to be 1 case per 1300-15,000 live births. | ||
Treatment for the disease is similar to treatment for [[congestive heart failure]]. [[Delivery]] is the recommeded overall treatment to decrease the volume load, improve ventricular function and simplify the medical management of these patients. | Treatment for the disease is similar to treatment for [[congestive heart failure]]. [[Delivery]] is the recommeded overall treatment to decrease the volume load, improve ventricular function and simplify the medical management of these patients. | ||
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*Estimates of incidence 1/1300-15000. Previous studies likely overestimated | *Estimates of incidence 1/1300-15000. Previous studies likely overestimated | ||
*More common in women with: | *More common in women with: | ||
:*Multiple pregnancies | :*Multiple pregnancies, | ||
:*African decent | :*African decent, | ||
:*h/o toxemia | :*h/o toxemia, | ||
:*Long-term tocolytic use | :*Long-term tocolytic use, | ||
:*Age>30 | :*Age >30, | ||
:*Twin Pregnancy | :*Twin Pregnancy. | ||
==Cause== | |||
The etiology of postpartum cardiomyopathy is unknown. As with other forms of [[dilated cardiomyopathy]], [[PPCM]] involves decrease of the [[left ventricle|left ventricular]] [[ejection fraction]] with associated [[congestive heart failure]] and increased risk of atrial and ventricular [[arrhythmia]]s and even [[sudden cardiac death]]. | |||
==History and Symptoms== | |||
Signs and symptoms are similar to those of normal pregnancy | |||
==Hemodynamic Findings== | ==Hemodynamic Findings== | ||
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!width="225"|Peripartum cardiomyopathy | !width="225"|Peripartum cardiomyopathy | ||
|- | |- | ||
|align="center"| | |align="center"|[[Right atrium]] ||align="center"|2 || align="center"|11 (2-34) | ||
|- | |- | ||
|align="center"| | |align="center"|[[Pulmonary artery]] ||align="center"|11 || align="center"|39 (18-62) | ||
|- | |- | ||
|align="center"| | |align="center"|[[Pulmonary capillary wedge pressure]] ||align="center"| 6 || align="center"|18 (5-32) | ||
|- | |- | ||
|align="center"|CO (L/min) ||align="center"| 7 ||align="center"|6 (5-9) | |align="center"|[[CO|Cardiac output (L/min)]] ||align="center"| 7 ||align="center"|6 (5-9) | ||
|- | |- | ||
|align="center"| | |align="center"|[[Heart rate]] ||align="center"|83 ||align="center"|104 (76-142) | ||
|} | |} | ||
==Treatment | ==Treatment== | ||
* [[Delivery]] is the recommeded overall treatment to decrease the volume load, improve ventricular function and simplify the medical management of these patients. | |||
* [[Digoxin]] and diuretics are Class C | =====Pharmacotherapy:===== | ||
* [[ACE inhibitors]] absolutely contraindicated prepartum ([[hydralazine]] drug of choice) | * [[Digoxin]] and [[diuretics]] are Class C recommendation. | ||
* Anticoagulation recommended ([[ | * [[ACE inhibitors]] absolutely contraindicated prepartum ([[hydralazine]] drug of choice). | ||
* [[Anticoagulation]] recommended ([[heparin]] prepartum and [[coumadin]] postpartum). | |||
== | ==Prognosis== | ||
* Mortality 25-50% (half deaths in first 3 months) | * Mortality 25-50% (half deaths in first 3 months). | ||
* Remainder stable/recover within 6 months | * Remainder stable/recover within 6 months. | ||
* Can recur with subsequent pregnancies | * Can recur with subsequent pregnancies. | ||
* Favorable outcomes with cardiac transplantation | * Favorable outcomes with [[cardiac transplantation]]. | ||
==References== | ==References== |
Revision as of 19:17, 18 April 2012
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Cardiac disease in pregnancy and peripartum cardiomyopathy On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Anjan K. Chakrabarti, M.D. [3]
Synonyms and Keywords: PPCM;
Overview
Peripartum cardiomyopathy (PPCM) is a form of dilated cardiomyopathy that is defined as a deterioration in cardiac function presenting between the last month of gestation and up to five months post-partum.
The etiology of postpartum cardiomyopathy is unknown. Reported prevalence of postpartum cardiomyopathy in United States is estimated to be 1 case per 1300-15,000 live births.
Treatment for the disease is similar to treatment for congestive heart failure. Delivery is the recommeded overall treatment to decrease the volume load, improve ventricular function and simplify the medical management of these patients.
Definition
Peripartum cardiomyopathy is defined as:
- Heart failure within last month of pregnancy or five months postpartum
- Absence of prior heart disease
- No determinable cause
- Strict echocardiographic indication of left ventricular dysfunction:
- Ejection fraction <45% and/or
- Fractional shortening <30%
- End-diastolic dimension >2.7 cm/m2 BSA (body surface area)
Common Mimickers
- Accelerated HTN
- Infection/sepsis
- Diastolic dysfunction
- High output state of pregnancy
Demographics
- Estimates of incidence 1/1300-15000. Previous studies likely overestimated
- More common in women with:
- Multiple pregnancies,
- African decent,
- h/o toxemia,
- Long-term tocolytic use,
- Age >30,
- Twin Pregnancy.
Cause
The etiology of postpartum cardiomyopathy is unknown. As with other forms of dilated cardiomyopathy, PPCM involves decrease of the left ventricular ejection fraction with associated congestive heart failure and increased risk of atrial and ventricular arrhythmias and even sudden cardiac death.
History and Symptoms
Signs and symptoms are similar to those of normal pregnancy
Hemodynamic Findings
Chamber | Normal Pregnancy | Peripartum cardiomyopathy |
---|---|---|
Right atrium | 2 | 11 (2-34) |
Pulmonary artery | 11 | 39 (18-62) |
Pulmonary capillary wedge pressure | 6 | 18 (5-32) |
Cardiac output (L/min) | 7 | 6 (5-9) |
Heart rate | 83 | 104 (76-142) |
Treatment
- Delivery is the recommeded overall treatment to decrease the volume load, improve ventricular function and simplify the medical management of these patients.
Pharmacotherapy:
- Digoxin and diuretics are Class C recommendation.
- ACE inhibitors absolutely contraindicated prepartum (hydralazine drug of choice).
- Anticoagulation recommended (heparin prepartum and coumadin postpartum).
Prognosis
- Mortality 25-50% (half deaths in first 3 months).
- Remainder stable/recover within 6 months.
- Can recur with subsequent pregnancies.
- Favorable outcomes with cardiac transplantation.