Peripartum cardiomyopathy

Abstract

Congestive heart failure is an uncommon complication of pregnancy with potentially life-threatening consequences. Peripartum cardiomyopathy is a disease of unknown cause in which severe left ventricular dysfunction occurs during late pregnancy or the early puerperium. In the past, the diagnosis of this entity was made on clinical grounds; however, modern echocardiographic techniques have allowed more accurate diagnoses by excluding cases of diseases that mimic the clinical symptoms and signs of heart failure. Risk factors for peripartum cardiomyopathy include advanced maternal age, multiparity, African descent, twinning, and long-term tocolysis. An extensive search for the causes of peripartum cardiomyopathy has been unrevealing. Treatment includes digitalis, diuretic agents, and vasodilators. Anticoagulation is strongly recommended, especially if ventricular function is persistent. The prognosis of peripartum cardiomyopathy is related to the recovery of ventricular function. Caution is advised in recommending subsequent pregnancy, especially if left ventricular dysfunction is persistent.

Combined spinal-epidural anesthesia for Cesarean section in a patient with peripartum dilated cardiomyopathy

“…Common misdiagnoses include other types of cardiomyopathy, valvulopathies, accelerated hypertension, diastolic ventricular dysfunction, systemic infection, pulmonary embolism, etc. 4 There is an increased incidence with multiple gestation, preeclampsia, obesity, advanced maternal age, 1 African descent and prolonged tocolysis. 4 Treatment includes digitalis, diuretics, vasodilators, and anticoagulants.…”

“…4 There is an increased incidence with multiple gestation, preeclampsia, obesity, advanced maternal age, 1 African descent and prolonged tocolysis. 4 Treatment includes digitalis, diuretics, vasodilators, and anticoagulants. 4 If supportive treatment fails, cardiac transplantation may be indicated.…”

“…4 Treatment includes digitalis, diuretics, vasodilators, and anticoagulants. 4 If supportive treatment fails, cardiac transplantation may be indicated. 5 The prognosis is related to the recovery of ventricular function.…”

“…5 The prognosis is related to the recovery of ventricular function. 4 The mortality rate of peripartum cardiomyopathy is 30-60% and may be caused by severe pulmonary congestion, and/or thromboembolic events. 2,6 Survivors have a 50-80% risk of developing cardiac failure during future pregnancies, with an associated mortality rate of 60%.…”

Idiopathic dilated cardiomyopathy presenting in pregnancy

“…More recently, it has been suggested that echocardiographicall), demonstrable impairment in left ventricular function should be added as a fourth criterion. 3 The obstetric, anesthetic and medical management of peripartum cardiomyopathy has been described previously, but dilated cardiomyopathy first presenting in early pregnancy is unusual. Although the clinical features of our patient resembled those ofperiparturn cardiomyopathy, the early presentation gave rise to a number of additional clinical considerations.…”