Natural Course of Peripartum Cardiomyopathy

Abstract

Twenty-seven patients presented in the puerperium with cardiomegaly, abnormal 'ECG, and congestive cardiac failure and were considered to have peripartum cardiomyopathy (PPCM). The incidence of PPCM was significantly higher in women over 30 years of age, in women in their third or subsequent pregnancy, and in the presence of twins or toxemia. Within 6 months, 14 patients had normal sized hearts (group A), and 13 patients maintained cardiomegaly (group B).The 14 patients in group A have been followed for 3 to 21 years (average 10.7 years). Two have died of unrelated causes. Of the remaining 12, eight are functional class I and four are functional class II. Eight patients had 21 subsequent pregnancies, with no permanent deterioration of cardiac function. Of 13 patients in group B, 11 (85%) have died of congestive cardiac failure. Their average survival was 4.7 years; six of 11 were dead in 3 years. Their clinical course was punctuated by repeated admissions for congestive cardiac failure. Six had pulmonary emboli, one had a systemic embolus, and three of six patients with subsequent pregnancies deteriorated in the puerperium. Of the two surviving patients, one is functional class I and the other is functional class II.Therefore, in those patients in whom cardiomegaly persisted, the prognosis was poor, and subsequent pregnancies were likely to lead to permanent deterioration. In those in whom the heart size returned to normal the prognosis was excellent.

Ischemic neuropathy and rhabdomyolysis as presenting symptoms of postpartum cardiomyopathy

“…Our patient meet the criteria for PPCM as set forth by Demakis [1]. PPCM is observed in 1 of 3,000-4,000 live births [9] and mortality is approximately 15% despite optimal treatment [10].…”

“…These two distinct disease entities are rarely encountered in combination. In our case rhabdomyolysis and peripheral neuropathy were attributed to one common cause, namely ischaemia due to acute arterial thromboembolism as a complication of PPCM [1]. This diagnosis was delayed because the cardiovascular symptoms were not immediately recognized.…”

PERIPARTUM CARDIOMYOPATHY AND ANAESTHESIA (A Case Report)

“…It usually presents first time in the last trimester of pregnancy [3,4]. Peripartum cardiomyopathy is usually of dilated type and may present with congestive heart failure.…”

The peripartum anesthesiologist

“…1 Moreover, the incidence of peripartum cardiomyopathy (PPCM) is thought to range from 1 in 2,400 to 1 in 15,000 pregnancies; 2 however, a more recent review suggests an incidence of one in 3,000 to 4,000 pregnancies in western countries. 3 Peripartum cardiomyopathy is more prevalent in older multiparous patients of African descent who have multiple gestations, chronic hypertension or preeclampsia, and have received prolonged tocolytic therapy.…”

“…1 De plus, l'incidence de la cardiomyopathie du péripartum (CMPP) est estimée entre 1 pour 2 400 et 1 pour 15 000 grossesses. 2 Toutefois, une analyse plus récente suggère une incidence d'un cas pour 3 000 à 4 000 grossesses dans les pays occidentaux.…”