Peripartum cardiomyopathy: current management and future perspectives

Abstract

Pregnancy is associated with marked physiological changes challenging the cardiovascular system. Among the more severe pregnancy associated cardiovascular complications, peripartum cardiomyopathy (PPCM) is a potentially life-threatening heart disease emerging towards the end of pregnancy or in the first postpartal months in previously healthy women. A major challenge is to distinguish the peripartum discomforts in healthy women (fatigue, shortness of breath, and oedema) from the pathological symptoms of PPCM. Moreover, pregnancy-related pathologies such as preeclampsia, myocarditis, or underlying genetic disease show overlapping symptoms with PPCM. Difficulties in diagnosis and the discrimination from other pathological conditions in pregnancy may explain why PPCM is still underestimated. Additionally, underlying pathophysiologies are poorly understood, biomarkers are scarce and treatment options in general limited. Experience in long-term prognosis and management including subsequent pregnancies is just beginning to emerge. This review focuses on novel aspects of physiological and pathophysiological changes of the maternal cardiovascular system by comparing normal conditions, hypertensive complications, genetic aspects, and infectious disease in PPCM-pregnancies. It also presents clinical and basic science data on the current state of knowledge on PPCM and brings them in context thereby highlighting promising new insights in diagnostic tools and therapeutic approaches and management.

A contemporary review of peripartum cardiomyopathy

“…In patients with intolerance or suboptimal rate control despite use of beta blocker therapy, ivabradine can be considered as per findings from registries in the ESC Euro observational programme. 26 This has negative chronotropic effects via suppression of the I f channel in the sinoatrial node. It does not compromise blood pressure, due to compensatory increase in stroke volume, but is ineffective in the context of coexistent atrial fibrillation.…”

“…Mineralocorticoid receptor antagonists, such as spironolactone and eplerenone, are generally recommended in patients with LVEF<40%. 26 Inotropic support is reserved for patients with haemodynamic instability in the context of acute decompensation.…”

Treatment of Peripartum Cardiomyopathy (Review)

“…Учитывая, что у некоторых больных наблюдается медленное восстановление функции сердца (до 5 лет после диагноза), больным с устой-чиво сниженной ФВ ЛЖ стандартное лечение СН может быть пролонгировано на годы или даже по-жизненно [32].…”

“…Поэтому, представляется целесо-образным опыт некоторых специалистов, предлага-ющих продлевать лекарственную терапию СН при ПКМП с использованием ИАПФ, β-АБ, антагони-стов минералокортикоидных рецепторов и др. на срок не менее 6 мес после полного восстановления функции ЛЖ, а затем придерживаться подхода мед-ленного уменьшения дозировок препаратов [32].…”

“…Сердечно-сосудистые осложнения, развивающиеся примерно у 1-4% беременных, в 10-20% случаев ста-новятся причиной материнской смертности [32,35]. Даже в экономически развитых странах уровень ма-теринской летальности, обусловленной кардиальной патологии, в последние годы имеет парадоксальную тенденцию к возрастанию [40,53].…”