Peripartum cardiomyopathy
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Background
- Uncommon cause of heart failure
- Usually occurs in last month of pregnancy or first five months postpartum
Clinical Features
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
- [ECG]]
- CXR
- CBC
- Chemistry
- TSH
- TTE
Diagnosis
- Presentation similar to typical CHF
- 4 criteria needed to meet definition for PPCM:
- 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
Prognosis[1]
- 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
- ↑ Bhattacharyya A et Al. Peripartum Cardiomyopathy: A Review. Tex Heart Inst J. 2012; 39(1): 8–16.
- 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.