Difference between revisions of "Peripartum cardiomyopathy"

(Workup)
(Management)
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==Management==
 
==Management==
*Treat like usual heart failure (except avoid nitroprusside and ACEI)
+
*Treat like usual heart failure (except avoid nitroprusside and ACEI in pregnancy)
 +
*If pregnant, fetal monitoring can assist in evaluating uterine perfusion
 +
*Avoid phenylephrine and norepinephrine if pregnant due to increased vasoconstriction of uterine arteries leading to placental insufficiency
 +
*Consider anticoagulation for EF <30% during pregnancy and within 2-3 months following delivery (avoid warfarin and DAOCs)
 +
*Beta-blockers improve survival and are safe in pregnancy, but should not be given in acute decompensated heart failure
  
 
==Disposition==
 
==Disposition==

Revision as of 23:52, 20 August 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

  • ECG
  • CXR
  • CBC & LFTs, screen for thrombocytopenia or transaminitis that can be found with severe pre-eclampsia
  • Chemistry
  • TSH
  • TTE, bedside can show LV dilation and LV systolic dysfunction
  • BNP

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 in pregnancy)
  • If pregnant, fetal monitoring can assist in evaluating uterine perfusion
  • Avoid phenylephrine and norepinephrine if pregnant due to increased vasoconstriction of uterine arteries leading to placental insufficiency
  • Consider anticoagulation for EF <30% during pregnancy and within 2-3 months following delivery (avoid warfarin and DAOCs)
  • Beta-blockers improve survival and are safe in pregnancy, but should not be given in acute decompensated heart failure

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.