Peripartum Cardiomyopathy

Peripartum Cardiomyopathy Definition

Peripartum Cardiomyopathy (PPCM) is a type of dilated cardiomyopathy which is characterized by deterioration in the cardiac function presenting usually sometime between the final month of pregnancy and five months after delivery. Women who have this heart disorder do not generally have any underlying heart problems or any specific reasons for developing heart diseases.

The heart failure resulting from PPCM can be temporary and curable or can advance to a life-threatening stage. It is associated with a considerable mortality rate.

Peripartum Cardiomyopathy Incidence

It is a rare health problem occurring only in 1 out of every 1300-4000 live births in the United States. PPCM can occur in all countries and races, but is more prevalent among certain people such as South African Bantus and Haiti.

Peripartum Cardiomyopathy Causes

Its exact etiology is still not known.

Various researches suggest certain health conditions including myocarditis (heart muscle inflammation), maladaptive response to hemodynamic stress of pregnancy and abnormal immune reaction to pregnancy. Scientists are carrying out tests and experiments for establishing the pathophysiology of PPCM. It may be associated with certain inflammatory proteins which can sometimes be present in blood during pregnancy. Some studies show that fetal cells may sometimes escape into the blood stream of the mother, leading to an immune reaction which causes myocarditis. Genetic predisposition has also been suggested as a possible cause of the disease. Other possible risk factors include:

  • Obesity
  • Multiple pregnancies
  • Advanced maternal age
  • Alcoholism
  • Smoking
  • Gestational hypertension
  • Malnutrition
  • Certain medications
  • Preeclampsia

Factors like the use of some tocolytic agents, developing toxemia of pregnancy (preeclampsia) and PIH (pregnancy-induced hypertension) may trigger or worsen heart failure. However, these are not counted among the risk factors for PPCM.

Peripartum Cardiomyopathy Symptoms

The common symptoms of this postpartum condition are mentioned below:

  • Palpitations or abnormally rapid heartbeats
  • Fatigue
  • Rapid pulse rate
  • Increase in the frequency of urination, especially at night
  • Pulmonary Edema (fluid accumulation in the lungs)
  • Shortness of breath, especially when exercising and lying flat (Orthopnea)
  • Respiratory problems
  • Weight gain
  • Loss of appetite
  • Fainting spells
  • Swollen feet, ankles, legs and hands
  • Neck vein swelling

Peripartum Cardiomyopathy Diagnosis

Physicians perform a physical examination to detect any signs of cardiomyopathy development. A stethoscope is used for observing any signs of fluid buildup in the lungs. Identifying any abnormal sounds in the heart and lungs such as a crackling in the lungs and a murmuring sound of systolic ejection can also indicate the possibility of the disorder. Physicians also perform tests for detecting signs of swelling in the liver of patients and monitoring their blood pressure carefully to see whether it increases when the sufferer stands up. Other symptoms in the diagnostic criteria of PPCM include the absence of any prior heart condition and left ventricular dysfunction shown on echocardiogram reports.

A number of diagnostic tests are used for making this diagnosis, including:

  • Chest x-ray
  • Chest CT scan
  • Cardiac MRI
  • Echocardiogram
  • Coronary angiography
  • Nuclear heart scan
  • Heart biopsy (only if the presence of myocarditis is suspected)
  • Electrocardiography (EKG)

Peripartum Cardiomyopathy Differential Diagnosis

A diagnostician should take care to rule out the following disorders while determining the presence of PPCM:

  • Myocardial infection
  • Valvular heart disease
  • Idiopathic Dilated Cardiomyopathy
  • Pulmonary Thromboembolism
  • Severe Eclampsia
  • HIV cardiomyopathy
  • Pneumonia

Peripartum Cardiomyopathy Treatment and Management

Early detection and prompt treatment are very important for increasing a patient’s chances of survival. The treatment for this condition is similar to that of another disorder named Congestive Heart Failure. The heart dysfunction occurring due to postpartum Cardiomyopathy can be reversed with proper treatment. However, the duration of the treatment depends on the stage of the disease and severity of the symptoms. In mild cases, the treatment focuses of relieving the symptoms with certain medications. Drugs used for this purpose include:

  • Digitalis for strengthening the heart and increasing its pumping ability
  • Low-dose beta-blockers (B-B)
  • Diuretics or water pills for removing excess fluid
  • Angiotensin-Converting Enzyme Inhibitors (ACE-I)

B-B and ACE-I medicines improve the blood circulation and reverses the dysfunction of the immune system responsible for PPCM. If the patient does not respond well to the ACE-I, it is replaced by ARB or angiotensin receptor blockers. Women in last stage of their pregnancy and breastfeeding mother are prescribed Hydralazine with nitrates instead of ACE-I.

Severe cases of the disease may require hospitalization. The following treatment options are used for managing such serious cases:

  • The functioning of the heart can be improved by using an aortic counterpulsation balloon or balloon heart pump
  • Immunosuppressive therapy can help to reduce the immune system dysfunction

Women with this type of Cardiomyopathy should be provided with special anesthetic care at the time of labor and delivery. The delivery is performed at a hospital where anesthesiologists will be present to address any complication that may arise while giving birth or after delivering the child.

Surgical Treatment

Heart transplantation may be necessary if the congestive heart failure refuses to go away with any of the above treatments. Less than 35% ejection fraction (EF) indicates anticoagulation which considerably increases the risk of left ventricular blood clots (thrombi). A LVAD (left ventricular assist device) implantation may be necessary for managing the disorder.


Peripartum Cardiomyopathy Prognosis

The prognosis of this disease varies from one patient to another. Some patients may recover and remain stable for a long time while in others, the disease may deteriorate over time. In extremely severe cases, the patient’s condition worsens very rapidly and heart transplant may be the only treatment option for them. The survival rate of the patients can be improved by early diagnosis and timely treatment.

Studies show the recurrence rate of PPCM to be minimal once completely cured, as long as there are no subsequent pregnancies.

Peripartum Cardiomyopathy Complications

Possible complications of the disorder are mentioned below:

  • Congestive heart failure
  • Cardiac arrhythmias (May turn fatal)
  • Pulmonary emboli (blood clotting in lungs)

Combined (estrogen/progestin) oral contraceptives are contraindicated in PPCM as they can lead to various complications.

Peripartum Cardiomyopathy Prevention

Following a well-balanced and nutritious diet, along with regular exercise, helps to improve cardiovascular fitness. Avoiding alcohol and cigarettes also helps in preventing this cardiac condition. Women who have already suffered from heart failure related to pregnancy should avoid getting pregnant in the future.

Peripartum Cardiomyopathy Life Expectancy

Many women with this form of Cardiomyopathy recover completely and have a normal life expectancy. Prompt treatment with implantable defibrillators has considerably decreased the sudden death risk in the patients. Still, the condition is associated with a death rate as high as 25% to 50%.

Peripartum Cardiomyopathy Images

The following images show how PPCM affects the heart.

Picture 1 – Peripartum Cardiomyopathy

Picture 2 – Peripartum Cardiomyopathy Image

Peripartum Cardiomyopathy is a serious and potentially fatal disorder that requires early diagnosis. Delayed detection and treatment may make it impossible to save the patient’s life. However, the affected women are allowed to lead a long and normal life with timely and suitable treatment. A number of support groups have been established who provide treatment guidelines to help PPCM patients fight the condition.

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