Peripartum Cardiomyopathy

Peripartum cardiomyopathy (PPCM) is an idiopathic dilated cardiomyopathy occurring in the last month of gestation through the first 5 months postpartum. Although the cause is unknown myocarditis and autoimmune process are the most likely causes. It generally it occurs in women over the age of 30 and there is a strong association with gestational hypertension.

PPCM presents like any other cause of congestive heart failure. Dyspnea on exertion, orthopnea, and fatigue in the early postpartum period may be the only symptoms of PPCM. Other symptoms that should lead to the consideration of PPCM are persistent weight retention or weight gain, peripheral edema, chest pain, new murmurs, pulmonary rales, JVD and nocturnal cough. Remember that the diagnosis presents a challenge due to the occurrence of symptoms in late pregnancy that mimics CHF including dyspnea, fatigue and pedal edema. Systemic and pulmonary embolism are common in PPCM.

The treatment of PPCM is similar to the treatment of acute and chronic heart failure. Intravenous nitroglycerin, dobutamine, dopamine, milrinone and lasix are safe to use in  pregnant patients if necessary for acute treatment. Anticoagulation should be started in all PPCM patients due to the risk of embolism (warfarin is contraindicated during pregnancy). ACE inhibitors (contraindicated during pregnancy) and Bblockers (relatively contraindicated) are indicated for long-term management in all PPCM patients.

Half of patients recover baseline ventricular function within 6 months of delivery. Mortality ranges from 18-58%.

Abboud J, Murad Y, Chen-Scarabelli C, Saravolatz L, Scarabelli TM. Peripartum cardiomyopathy: a comprehensive review. Int J Cardiol. 2007 Jun 12;118(3):295-303.

Murali S, Baldisseri MR. Peripartum cardiomyopathy. Crit Care Med. 2005 Oct;33(10 Suppl):S340-6.