Peripartum Cardiomyopathy

Last updated 03.11.12

 

Index

 

Definition

-  Rare form of dilated cardiomyopathy causing CCF from the last month of pregnancy up to the 1st 5 months post partum

 

Features

-  Idiopathic ?viral ? autoimmune

-  Incidence 1:3000 +/-

-  ? Higher incidence in afro-carribean population

-  Higher risk if pre-existing HTN or twins

-  Dx of exclusion

-  May resolve over months/yrs or leave permanent impairment

-  50%+ complete recovery (LVEF > 50%) wo need for ongoing meds

-  21% risk of recurrence in future pregnancies

 

Associated S/S

-  Dilation of left ventricle with decreased LVEF (< 45%)

-  Atrial or ventricular arythmias: AF

-  Thromboembolism: Stroke, AMI, PE

-  CCF

-  Orthopnoea, dyspnoea, oedema, nocturia, palpitations, chest pain

 

Ix

-  CXR: pulmonary oedema

-  Echo: LVEF, ventriculomegaly, poor contractility, thrombosis

 

Mx

-  Avoid pregnancy if LVEF < 55%

-  LVEF < 35% anticoagulate

-  4-10% require heart transplant

-  Left ventricular assist device whilst waiting

-  Meds as per heart failure

-  Avoid ACEI if breast feeding

-  Hydralazine, Nitrate, ACEI/ARBs, Frusemide

 

 

 

References