Safe and Effective Use of Pharmacologic and Device Therapy for Peripartum Cardiomyopathy

Laliberte, Benjamin; Reed, Brent N.; Ather, Ayesha; Devabhakthuni, Sandeep; Watson, Kristin; Lardieri, Allison; Smith, Connie U.

doi:10.1002/phar.1795

Cited by 11 publications

(3 citation statements)

References 65 publications

(291 reference statements)

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“…Hydralazine and nitrates may be used as vasodilator therapy. On the basis of the RALES and EMPHASIS-HF trials,120121 mineralocorticoid receptor antagonists are indicated in patients with NYHA II-IV heart failure and an LVEF ≤35%114; these agents should be avoided during pregnancy because of their anti-androgenic effects117 but may be used during breast feeding 122. Digoxin may be used safely in pregnancy 123…”

Section: Management Of Peripartum Cardiomyopathymentioning

confidence: 99%

Peripartum cardiomyopathy

Honigberg

Givertz

2019

BMJ

145

154

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Peripartum cardiomyopathy (PPCM) is a rare, often dilated, cardiomyopathy with systolic dysfunction that presents in late pregnancy or, more commonly, the early postpartum period. Although the condition is prevalent worldwide, women with black ancestry seem to be at greatest risk, and the condition has a particularly high incidence in Nigeria and Haiti. Other risk factors include pre-eclampsia, advanced maternal age, and multiple gestation pregnancy. Although the complete pathophysiology of peripartum cardiomyopathy remains unclear, research over the past decade suggests the importance of vasculo-hormonal pathways in women with underlying susceptibility. At least some women with the condition harbor an underlying sarcomere gene mutation. More than half of affected women recover systolic function, although some are left with a chronic cardiomyopathy, and a minority requires mechanical support or cardiac transplantation (or both). Other potential complications include thromboembolism and arrhythmia. Currently, management entails standard treatments for heart failure with reduced ejection fraction, with attention to minimizing potential adverse effects on the fetus in women who are still pregnant. Bromocriptine is one potential disease specific treatment under investigation. In this review, we summarize the current literature on peripartum cardiomyopathy, as well as gaps in the understanding of this condition and future research directions.

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Section: Management Of Peripartum Cardiomyopathymentioning

confidence: 99%

Peripartum cardiomyopathy

Honigberg

Givertz

2019

BMJ

145

154

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“…All angiotensin converting enzyme inhibitors, angiotensin receptor blockers, including sacubitril-valsartan are contraindicated in pregnant women [42]. Mineralocorticoid receptor antagonists should be avoided during pregnancy in view of their anti-androgenic effects, although they may be taken during breast feeding [43]. Digoxin may be safely used in pregnancy [44].…”

Section: Managementmentioning

confidence: 99%

Peripartum cardiomyopathy: A 2022 update

Dash¹,

Rohit²,

Malan³

et al. 2022

Iberoam J Med

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Peripartum cardiomyopathy (PPCM) is a rare but life-threatening condition defined by left ventricular dysfunction and heart failure (HF), occurring in late pregnancy or, more commonly, the early postpartum period. In African American women, women with pre-eclampsia, advanced maternal age, and numerous gestation pregnancies, there is a greater incidence. Although the pathophysiology of PPCM is still undetermined, the importance of vasculo-hormonal pathways has been suggested in research over the past decades. Sarcomere genetic polymorphisms are found in at least some women with the disorder. More than 50% of the patients recover systolic function, albeit some are left with chronic cardiomyopathy, and a small minority of patients requires mechanical support or cardiac transplantation, or both. For the diagnosis of PPCM, electrocardiographic findings of decreased myocardial function are essential. Currently, the management of PPCM is limited to standard treatments for HF with reduced ejection fraction, with attention to minimizing the potential adverse effects on the fetus in women who are still pregnant. As a result, the outcome might range from full recovery to persistent HF, arrhythmia, thromboembolic events, or death. Research on PPCM is examined in this review, as are potential future paths for further study.

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“…However, intra-aortic balloon pumps, extracorporeal circulatory devices, and even left ventricular assist devices have been used during pregnancy. 144,145 Women with a history of peripartum cardiomyopathy are at risk of recurrence in a future pregnancy, even those who seem to have clinically and echocardiographically recovered.…”

Section: Peripartum Cardiomyopathymentioning

confidence: 99%

Obstetric Disorders in the ICU

Vásquez

Plante

Basualdo³

et al. 2017

Semin Respir Crit Care Med

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Pregnant and postpartum patients represent a challenge to critical care physicians, as two patients in one have to be cared for and because specific obstetric disorders, not universally covered in formal critical care training, need to be managed. Pregnancy also alters physiologic norms, so that the critical care physician may either fail to recognize a value as abnormal in pregnancy or mistakenly identify as abnormal a value within the normal range for a pregnant woman. In this article, we will review the most frequent obstetric causes of admission of pregnant/postpartum patients to the intensive care unit (hypertensive disease of pregnancy, obstetric hemorrhage, and obstetric sepsis) along with their diagnostic criteria, clinical presentation, and recommended treatment. We will also cover some specific, although less frequent, obstetric disorders, such as acute fatty liver of pregnancy, peripartum cardiomyopathy, and amniotic fluid embolism. Our primary aim is to improve quality of care for these types of patients.

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Safe and Effective Use of Pharmacologic and Device Therapy for Peripartum Cardiomyopathy

Cited by 11 publications

References 65 publications

Peripartum cardiomyopathy

Peripartum cardiomyopathy

Peripartum cardiomyopathy: A 2022 update

Obstetric Disorders in the ICU

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