Peripartum Cardiomyopathy: Risks Diagnosis and Management

Abstract

Peripartum cardiomyopathy is a rare cause of heart failure that occurs during late pregnancy or in the early postpartum period. Delays in diagnosis may occur as symptoms of heart failure mimic those of normal pregnancy. The diagnosis should be considered in any pregnant or postpartum woman with symptoms concerning for heart failure. If there are clinical concerns, labs including N-terminal pro-BNP should be checked, and an echocardiogram should be ordered to assess for systolic dysfunction. Prompt medical treatment tailored for pregnancy and lactation is essential to prevent adverse events. Outcomes are variable, including complete recovery, persistent myocardial dysfunction with heart failure symptoms, arrhythmias, thromboembolic events, and/or rapid deterioration requiring mechanical circulatory support and cardiac transplantation. It is essential that care is provided as part of a multidisciplinary cardio-obstetrics team including obstetrics, cardiology, maternal fetal medicine, anesthesiology, and nursing. All women with peripartum cardiomyopathy should have close follow-up with a cardiologist, although optimal duration of medical therapy following complete recovery is unknown. Women considering a subsequent pregnancy require preconception counseling and close collaboration between obstetrics and cardiology throughout pregnancy.

Keywords: cardiomyopathy; heart failure; peripartum; pregnancy.

Figure 1

Presentation, risk factors, diagnosis, and management of peripartum cardiomyopathy (PPCM).

Figure 2

Subsequent pregnancy for patients with history of PPCM. The risks and recommendations vary based on the patient’s LVEF recovery status. The risks are much higher in those with non-recovered PPCM (LVEF <50%) and pregnancy should be discouraged in these patients.