Peripartum cardiomyopathy: Difference between revisions

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==Background==
==Background==
*Development of heart failure in last month of pregnancy or w/in 5mo of delivery
*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>


==Diagnosis==
==Clinical Features==
*Presentation similar to typical CHF
*Peripartum with presentation similar to typical [[CHF]]
*Absence of an identifiable cause for the heart failure
**Usually occurs in last month of pregnancy or first five months postpartum
*Absence of recognizable heart disease prior to the last month of pregnancy
*LV systolic dysfunction


==DDX==
==Differential Diagnosis==
*Respiratory tract infection
*Respiratory tract infection
*PE
*[[PE]]
*MI
*[[MI]]
*Postpartum fluid overload
*Postpartum fluid overload


==Work-Up==
{{Cardiomyopathy DDX}}
#ECG
#CXR
#CBC
#Chemistry
#TSH
#TTE


==Treatment==
{{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)]]


==Source==
==References==
Tintinalli
<references/>


[[Category:OB/GYN]]
[[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

  • Respiratory tract infection
  • PE
  • MI
  • Postpartum fluid overload

Cardiomyopathy

3rd Trimester/Postpartum Emergencies

Evaluation

Workup

Diagnosis

4 criteria needed to meet definition:[2]

  1. Development of heart failure in last month of pregnancy or within 5 month postpartum
  2. No identifiable alternate cause of heart failure
  3. No pre-existing heart disease
  4. 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

  1. 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
  2. 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.
  3. Bhattacharyya A et Al. Peripartum Cardiomyopathy: A Review. Tex Heart Inst J. 2012; 39(1): 8–16.