Unveiling the Mystery of Peripartum Cardiomyopathy: A Traditional Review

Abstract

Peripartum cardiomyopathy (PPCM) can be classified as a variant of dilated cardiomyopathy identified usually within the first five months of delivery or during the last month of pregnancy. This condition presents as systolic heart failure. PPCM affects thousands of women in the United States each year. Even though it was first noticed in the 1800s, its etiology remains unknown. This study aims to review the pathophysiology and management of PPCM and explore the possible outcomes of peripartum cardiomyopathy. PPCM can lead to maternal death if diagnosis or treatment is delayed. Diagnosing PPCM has been challenging because it can be misdiagnosed or perceived as a sign of pregnancy since most of the symptoms of PPCM strongly match those within the typical pregnancy continuum and postpartum cycle. Patients' implications are fatal and carry a high mortality rate when PPCM is misdiagnosed or treatment is delayed. To accurately identify PPCM, using echocardiography, the left ventricular end-diastolic size and the ejection fraction should be measured to determine the severity of PPCM. Managing peripartum cardiomyopathy involves using traditional treatments for heart failure. Therapeutic recommendations are made depending on the patient's status (pregnancy, breastfeeding, postpartum) while considering the drugsafety profiles before administration. Some other treatments have also been used to control PPCM depending on how severe it has become; for example, antiarrhythmics have been used to treat cardiac arrhythmias when they ensue. In extreme cases, mechanical assistance and transplantation could be required. Based on the proposed pathophysiology involving the 16kDA anti-angiogenic sub-fragment, bromocriptine may be used even though it still needs more assessment due to limited evidence. Using PubMed as a major search resource, a thorough analysis of publications was carried out after incorporating this review's inclusion and exclusion criteria. A total of 455,141 publications were found using keywords and keyword combinations. With a careful selection of articles, 31 publications provided relevant information on our primary endpoint. All articles in this examination were chosen without limitation to the type of study, including clinical trials, review articles, meta-analyses, and so on. Our review suggests that, based on factors such as early detection and management, disease severity, ethnicity, and quality of patient care, patients with PPCM presented different outcomes and prognosis. However, despite PPCM's high mortality rate and its risk of recurrence, most patients tend to recover within six months of disease onset.

Pulmonary Embolism in Patients Admitted With Peripartum Cardiomyopathy: Prevalence, Predictors, and Associated In-Hospital Adverse Events

“…The pathophysiology of PPCM is not well understood, but it is thought to be mediated by the hormonal changes of pregnancy, with genetic predisposition postulated to play a role [ 5 ]. The antiangiogenic and cardiotoxic effects of the N-terminal 16 kDa fragment of prolactin, later named vasoinhibin, have been well documented, and the elevated prolactin in the peripartum period makes these patients susceptible to endothelial cell damage and ventricular wall angiogenesis [ 2 , 6 , 7 ].…”

“…A definitive diagnosis can be made with an echocardiogram showing LV systolic dysfunction in a patient with no other source of heart failure [ 4 ]. An echocardiogram is an obligatory part of the PPCM workup to rule out an LV thrombus as soon as possible [ 5 ]. High levels of brain natriuretic peptide, as well as electrocardiographic abnormalities identical to those in acute heart failure, can further support a diagnosis of PPCM [ 4 ].…”

Peripartum cardiomyopathy: current theories about etiopathogenesis, potential biomarkers and treatment - a literature review

“…[5,8,24] 3. CZYNNIKI RYZYKA Do czynników ryzyka rozwoju PPCM zalicza się [1,5,12,14,16,22 [3,5,9,16]. Obecnie w literaturze spotyka się kryteria takie jak: 1.…”

Bromocriptine therapy: Review of mechanism of action, safety and tolerability

“…Based on the satisfactory outcomes, bromocriptine as a disease‐specific therapy has been broadly and successfully introduced in many animal models and human clinical trials for PPCM patients 103–106 . Prolactin release inhibition resulting in the reduction of 16‐kDa fragment with short‐term or even long‐term bromocriptine therapy, in addition to standard treatment for heart failure, is seen to be associated with increased recovery rate and negligibly low adverse outcome in patients with severe forms of PPCM, even no death and need of left ventricular assist device (LVAD) or heart transplantation have been observed 102,107–110 .…”

“…95,98,[100][101][102] Based on the satisfactory outcomes, bromocriptine as a diseasespecific therapy has been broadly and successfully introduced in many animal models and human clinical trials for PPCM patients. [103][104][105][106] Prolactin release inhibition resulting in the reduction of 16-kDa fragment with short-term or even long-term bromocriptine therapy, in addition to standard treatment for heart failure, is seen to be associated with increased recovery rate and negligibly low adverse outcome in patients with severe forms of PPCM, even no death and need of left ventricular assist device (LVAD) or heart transplantation have been observed. 102,[107][108][109][110] Such addition of bromocriptine to HF general therapy shows greater improvement in the left ventricular ejection fraction (LVEF) at 6-month follow-up treatment as compared to that of standard heart failure (HF) therapy alone, and most of the patients recover from functional class III-IV to class I according to the NYHA functional classification.…”