Peripartum cardiomyopathy: Difference between revisions
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==Background== | ==Background== | ||
* | *Uncommon cause of heart failure | ||
*Incidence: 1:968 to 1:4000 in the United States<ref>Sliwa K et al. | |||
Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail. 2010;12(8):767. PMID: | |||
20675664</ref> | |||
== | ==Clinical Features== | ||
* | *Peripartum with presentation similar to typical [[CHF]] | ||
* | **Usually occurs in last month of pregnancy or first five months postpartum | ||
* | |||
== | ==Differential Diagnosis== | ||
*Respiratory tract infection | *Respiratory tract infection | ||
*PE | *[[PE]] | ||
*MI | *[[MI]] | ||
*Postpartum fluid overload | *Postpartum fluid overload | ||
{{Cardiomyopathy DDX}} | |||
== | {{Postpartum emergencies DDX}} | ||
==Evaluation== | |||
===Workup=== | |||
*[[ECG]] | |||
*[[CXR]] | |||
*CBC | |||
*Chemistry | |||
*TSH | |||
*TTE | |||
===Diagnosis=== | |||
4 criteria needed to meet definition:<ref>Elkayam U et al. Pregnancy-associated cardiomyopathy: clinical characteristics and a comparison between early and late presentation. Circulation. 2005 Apr 26; 111(16): 2050-5.</ref> | |||
#Development of heart failure in last month of pregnancy or within 5 month postpartum | |||
#No identifiable alternate cause of heart failure | |||
#No pre-existing heart disease | |||
#LV ejection fraction < 45% | |||
==Management== | |||
*Treat like usual heart failure (except avoid nitroprusside and ACEI) | *Treat like usual heart failure (except avoid nitroprusside and ACEI) | ||
==Disposition== | |||
*Admit | |||
==Prognosis<ref>Bhattacharyya A et Al. Peripartum Cardiomyopathy: A Review. Tex Heart Inst J. 2012; 39(1): 8–16.</ref>== | |||
*Mortality rate up to 10% | |||
*High risk of recurrence in subsequent pregnancies | |||
*Many patients recover within 3 to 6 months of disease onset | |||
==See Also== | ==See Also== | ||
*[[Post-Partum Emergencies]] | *[[Post-Partum Emergencies]] | ||
*[[Cardiomyopathy]] | *[[Cardiomyopathy (Main)]] | ||
== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Cardiology]] | ||
[[Category:OBGYN]] |
Revision as of 15:08, 20 June 2019
Background
- Uncommon cause of heart failure
- Incidence: 1:968 to 1:4000 in the United States[1]
Clinical Features
- Peripartum with presentation similar to typical CHF
- Usually occurs in last month of pregnancy or first five months postpartum
Differential Diagnosis
Cardiomyopathy
- Dilated cardiomyopathy
- Hypertrophic cardiomyopathy
- Restrictive cardiomyopathy
- Peripartum cardiomyopathy
- Takotsubo cardiomyopathy
- Arrhythmogenic right ventricular dysplasia
3rd Trimester/Postpartum Emergencies
- Acute fatty liver of pregnancy
- Amniotic fluid embolus
- Chorioamnionitis
- Eclampsia
- HELLP syndrome
- Mastitis
- Peripartum cardiomyopathy
- Postpartum endometritis (postpartum PID)
- Postpartum headache
- Postpartum hemorrhage
- Preeclampsia
- Resuscitative hysterotomy
- Retained products of conception
- Septic abortion
- Uterine rupture
Evaluation
Workup
Diagnosis
4 criteria needed to meet definition:[2]
- Development of heart failure in last month of pregnancy or within 5 month postpartum
- No identifiable alternate cause of heart failure
- No pre-existing heart disease
- LV ejection fraction < 45%
Management
- Treat like usual heart failure (except avoid nitroprusside and ACEI)
Disposition
- Admit
Prognosis[3]
- Mortality rate up to 10%
- High risk of recurrence in subsequent pregnancies
- Many patients recover within 3 to 6 months of disease onset
See Also
References
- ↑ Sliwa K et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail. 2010;12(8):767. PMID: 20675664
- ↑ Elkayam U et al. Pregnancy-associated cardiomyopathy: clinical characteristics and a comparison between early and late presentation. Circulation. 2005 Apr 26; 111(16): 2050-5.
- ↑ Bhattacharyya A et Al. Peripartum Cardiomyopathy: A Review. Tex Heart Inst J. 2012; 39(1): 8–16.