Peripartum cardiomyopathy

Background

  • Uncommon cause of heart failure

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

Postpartum Emergencies

Evaluation

Workup

Diagnosis

4 criteria needed to meet definition:[1]

  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[2]

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