Peripartum Cardiomyopathy: a Review for the Clinician

Abstract

Purpose of review: This review summarizes the pathophysiology, diagnosis, and treatment of peripartum cardiomyopathy (PPCM), with a focus on recent discoveries of clinical relevance.

Recent findings: An increase in oxidative stress and anti-angiogenic activity play key roles in the pathophysiology of peripartum cardiomyopathy. Therapies that target this dysregulation may have a future role in treatment. Suppression of prolactin release using bromocriptine, a dopamine-receptor antagonist, has been associated with more favorable outcomes in small studies but more research is needed. Similarly, VEGF agonists may prove to be a novel therapy by upregulating angiogenesis. Peripartum cardimyopathy typically presents in the third trimester or in first few months postpartum. Both genetic and clinical risk factors for PPCM have been identified. Women with PPCM should be managed by a multidisciplinary team with experience in high risk pregnancy and the treatment of heart failure. These women benefit from the use of standard treatments for heart failure therapy with the exception of avoiding ACE inhibitors and ARBs while pregnant. While the rate of recovery of ventricular function in PPCM is higher than in other forms of dilated cardiomyopathy, mechanical circulatory support and/or cardiac transplantation are required in some cases.

Keywords: Beta-blockers and ACE inhibitors in breast feeding; Peripartum cardiomyopathy; Post-partum heart failure.