Cardiac disease in pregnancy and peripartum cardiomyopathy: Difference between revisions

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*Increase [[vasoconstriction]]
*Increase [[vasoconstriction]]
*Impair [[myocyte]] function
*Impair [[myocyte]] function
The potential role of [[prolactin]] forms the molecular basis of treatment with bromocriptine in the mouse.


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]].
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]].

Revision as of 23:59, 10 October 2012

Cardiac disease in pregnancy Microchapters

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I. Pre-existing Cardiac Disease:
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Pulmonary Hypertension
Rheumatic Heart Disease
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II. Valvular Heart Disease:
Mitral Stenosis
Mitral Regurgitation
Aortic Insufficiency
Aortic Stenosis
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III. Cardiomyopathy:
Dilated Cardiomyopathy
Hypertrophic Cardiomyopathy
Peripartum Cardiomyopathy
IV. Cardiac diseases that may develop During Pregnancy:
Arrhythmias
Acute Myocardial Infarction
Hypertension

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief:Anjan K. Chakrabarti, M.D. [2]

Synonyms and Keywords: PPCM; PPCMP

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 six 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:

  • Ejection fraction <45% and/or
  • Fractional shortening <30%
  • End-diastolic dimension >2.7 cm/m2 BSA (body surface area)

Pathophysiology

The etiology of postpartum cardiomyopathy is largely unknown. It has been postulated that a defective antioxidant mechanism may contribute. There are elevated levels of cathepsin D and an increase in total prolactin and angiostatic 16kDa prolactin. These molecules promote:

The potential role of prolactin forms the molecular basis of treatment with bromocriptine in the mouse.

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.

Differentiating Peripartum Cardiomyopathy from Other Disorders

Epidemiology and Demographics

  • Estimates of incidence 1/1300-15000. Previous studies likely overestimated

Risk Factors

PPCM is more common among women with:

  • Prior PPCM
  • Multiple pregnancies
  • African decent, Haitian descent
  • History of toxemia
  • Long-term tocolytic use
  • Age >30
  • Twin Pregnancy

Diagnosis

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:

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.

References


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