Peripartum cardiomyopathy

Background

• Uncommon cause of heart failure
• Usually occurs in last month of pregnancy or first five months postpartum

Clinical Features

• Peripartum with presentation similar to typical CHF

Differential Diagnosis

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

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

• ECG
• CXR
• CBC
• Chemistry
• TSH
• TTE

Diagnosis

4 criteria needed to meet definition for PPCM:

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)

Prognosis

• 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

• Post-Partum Emergencies
• Cardiomyopathy (Main)

References

• 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.