peripartum cardiomyopathy

Etiology

• idiopathic

Epidemiology

• 3.0% (1979-1984), 7.7% (1991-1997) of pregnancy-related deaths
• 2% of deaths occur before delivery 48% within 6 weeks after delivery 50% between 6 weeks & 1 year after delivery
• older mothers more likely to die from peripartum cardiomyopathy
• blacks at higher risk of death than whites

Clinical manifestations

• onset of heart failure in last month of pregnancy, or within 5 months of delivery
• 15% have pre-eclampsia or pregnancy-induced hypertension
• 5% with pulmonary embolism or embolic stroke
• commonly recurs with subsequent pregnancies

Management

• counsel all women to avoid future pregnancy
• ACE inhibitor or ARB +/- aldosterone antagonist, beta-blocker, diuretic in combination after delivery
  • prior to delivery, beta-blocker, digoxin, hydralazine, diuretics may be used
• bromocryptine may be of benefit
• prognosis:
  • 50% of women show improvement in LV systolic function within 6 months

More general terms

• cardiomyopathy
• pregnancy disorder; obstetric disorder; pregnancy complication