peripartum/postpartum cardiomyopathy
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Etiology
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 [1
- may present with fatigue, exertional dyspnea, cough, wheezing
Diagnostic procedures
- electrocardiogram]
- sinus tachycardia
- normal QRS axis & duration
- nonspecific ST-T wave abnormalities
- transthoracic echocardiography for evidence of heart failure
Radiology
- chest X-ray may show costophrenic angle blunting
Management
- counsel all women to avoid future pregnancy[1]
- ACE inhibitor or ARB +/- aldosterone antagonist, beta-blocker, diuretic in combination after delivery[1]
- prior to delivery, beta-blocker, digoxin, hydralazine, isosorbide dinitrate. & diuretics may be used
- if history of angioedema due to ACE inhibitor, amlodipine
- bromocryptine may be of benefit[3]
- prognosis:
- 50% of women show improvement in LV systolic function within 6 months
More general terms
References
- ↑ 1.0 1.1 1.2 Medical Knowledge Self Assessment Program (MKSAP) 14, 16, 18, 19. American College of Physicians, Philadelphia 2006, 2012, 2018, 2022.
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ Journal Watch 24(4):33, 2004
Whitehead SJ et al, Pregnancy-related mortality due to cardiomyopathy: United States, 1991-1997. Obstet Gynecol 102:1326, 2003 PMID: https://pubmed.ncbi.nlm.nih.gov/14662222 - ↑ 3.0 3.1 Sliwa K, Blauwet L, Tibazarwa K et al Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: a proof-of-concept pilot study. Circulation. 2010 Apr 6;121(13):1465-73. PMID: https://pubmed.ncbi.nlm.nih.gov/20308616
- ↑ Sliwa K, Hilfiker-Kleiner D, Petrie MC et al Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail. 2010 Aug;12(8):767-78. PMID: https://pubmed.ncbi.nlm.nih.gov/20675664
- ↑ Arany Z, Elkayam U. Peripartum Cardiomyopathy. Circulation. 2016 Apr 5;133(14):1397-409. Review. PMID: https://pubmed.ncbi.nlm.nih.gov/27045128
- ↑ Park K, Bairey Merz CN, Bello NA, et al; American College of Cardiology Cardiovascular Disease in Women Committee and the Cardio-Obstetrics Work Group. Management of women with acquired cardiovascular disease from pre-conception through pregnancy and postpartum: JACC Focus Seminar 3/5. J Am Coll Cardiol. 2021;77:1799-1812. PMID: https://pubmed.ncbi.nlm.nih.gov/33832606