Cardiac disease in pregnancy and peripartum cardiomyopathy

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III. Cardiomyopathy:
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Peripartum Cardiomyopathy
IV. Cardiac diseases that may develop During Pregnancy:
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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. 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.

In the US the prevalence is estimated to be 1 case per 1300-15,000 live births. The incidence of peripartum cardiomyopathy is increased in women over the age of 30, in twin pregnancies, in multiparous women, in women with gestational hypertension, those who have received tocolytic therapy, and in african americans.

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)

Common Mimickers

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
  • Etiology remains unknown
  • Signs and sxs similar to those of nl pregnancy

Hemodynamic Findings

Chamber Normal Pregnancy Peripartum cardiomyopathy
RA 2 11 (2-34)
PA 11 39 (18-62)
PCW 6 18 (5-32)
CO (L/min) 7 6 (5-9)
HR 83 104 (76-142)

Treatment of Peripartum Cardiomyopathy

Outcome of Peripartum Cardiomyopathy

  • 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

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