Peripartum Cardiomyopathy: Risks Diagnosis and Management

Abstract

Peripartum cardiomyopathy is a rare cause of heart failure that occurs during late pregnancy or in the early postpartum period. Delays in diagnosis may occur as symptoms of heart failure mimic those of normal pregnancy. The diagnosis should be considered in any pregnant or postpartum woman with symptoms concerning for heart failure. If there are clinical concerns, labs including N-terminal pro-BNP should be checked, and an echocardiogram should be ordered to assess for systolic dysfunction. Prompt medical treatment tailored for pregnancy and lactation is essential to prevent adverse events. Outcomes are variable, including complete recovery, persistent myocardial dysfunction with heart failure symptoms, arrhythmias, thromboembolic events, and/or rapid deterioration requiring mechanical circulatory support and cardiac transplantation. It is essential that care is provided as part of a multidisciplinary cardio-obstetrics team including obstetrics, cardiology, maternal fetal medicine, anesthesiology, and nursing. All women with peripartum cardiomyopathy should have close follow-up with a cardiologist, although optimal duration of medical therapy following complete recovery is unknown. Women considering a subsequent pregnancy require preconception counseling and close collaboration between obstetrics and cardiology throughout pregnancy.

Cardio-Obstetric Shock

“… 2 The most common cause of CS in pregnancy is PPCM, an idiopathic DCM presenting with LV systolic dysfunction in the later stages of pregnancy or early postpartum where no other cause is identified. 3 Based on our patient’s presentation with CS during the early hemodynamic demands of pregnancy when cardiac output is rising to maximal levels, and before the typical presentation of PPCM, we believe her presentation was most consistent with DCM.…”

Peripartum Cardiomyopathy Complicated by Ventricular Tachycardia during Labor: A Case Report and Literature Review

“…In the same study, the prevalence of hypertension and preeclampsia were markedly higher than in the general population. Other associations have been suggested, such as prolonged tocolysis, obesity, and diabetes [50].…”

Postpartum cardiomyopathy with congestive heart failure: A case report

“…Ongoing cardiologist follow-up is paramount for all postpartum cardiomyopathy patients, while preconception counseling and collaborative care between obstetrics and cardiology are imperative for women contemplating subsequent pregnancies. 14 – 17 …”

“…Therefore, clinicians should maintain a high index of suspicion for postpartum cardiomyopathy in pregnant or postpartum women presenting with symptoms suggestive of heart failure. 15 Postpartum cardiomyopathy diagnosis involves a comprehensive approach integrating clinical assessment and diagnostic modalities. Manifestations of heart failure in pregnant or postpartum individuals should prompt consideration of postpartum cardiomyopathy, prompting the need for diagnostic evaluation.…”