Peripartum cardiomyopathy
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Background
- Disease earlier than last month of pregnancy is likely the same process of HF
Diagnosis
- Presentation similar to typical CHF
- 4 criteria needed to meet definition for PPCM:
- Development of heart failure in last month of pregnancy or w/in 5mo of delivery
- Absence of an identifiable cause for the heart failure
- Absence of recognizable heart disease prior to the last month of pregnancy
- LV systolic dysfunction, such as LVEF < 45%
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
Work-Up
- ECG
- CXR
- CBC
- Chemistry
- TSH
- TTE
Treatment
- Treat like usual heart failure (except avoid nitroprusside and ACEI)
See Also
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.