What is peripartum dilated cardiomyopathy?

Updated: Nov 28, 2018
  • Author: Vinh Q Nguyen, MD; Chief Editor: Gyanendra K Sharma, MD, FACC, FASE  more...
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Answer

Physiologic changes accompanying pregnancy can pose challenges to the cardiovascular system. One of these challenges is peripartum cardiomyopathy (PPCM), which has the potential for significant morbidity and mortality. This condition is characterized by LV systolic dysfunction during the last trimester of pregnancy or the early puerperium period. Cardiomegaly persisting longer than 4-6 months carries a mortality of 50% at 6 years. Subsequent pregnancies in women with cardiomyopathy carries a substantial risk of clinical deterioration, particularly in those who did not recover LV function. In those with recovered LV function, the risk of clinical deterioration is less, but the cardiac dysfunction frequently emerges in the peripartum period. [13, 37] Patients with PPCM should be counseled about the risks that potential pregnancies may have on their health as well as the health of their fetus(es). Genetic forms of PPCM may be at higher risk for clinical nonrecovery,. [38]

Cardiovascular changes during pregnancy include expansion of plasma volume, increased cardiac output, and increased activity of the renin-angiotensin-aldosterone system that increases salt and water retention. [37, 38] During labor, there is the potential to overwhelm the cardiovascular system due to the increased cardiac output from tachycardia, catecholamine surges, and deposition of 300-500 mL of blood from the uterus into the maternal circulation. [37]

A number of biomarkers have been studied for the diagnosis and risk stratification of PPCM. The only commercially available marker with adequate efficiency is N-terminal pro b-type natriuretic peptide (NT-proBNP), which is not specific for PPCM but has good sensitivity for heart failure. Other biomarkers of interest include microRNA-146a (MiR-146a), soluble fms-like tyrosine kinase (SFlt1), and cathepsin D (CTSD). [37, 39, 40]

Therapy for PPCM includes standard guideline-directed management, with cautious use of diuretic therapy because placental perfusion may be impaired as well as initiating postdelivery ACE inhibitors due to their teratogenicity. The potential benefit of administering pentoxyfylline or bromocriptine in addition to heart failure medications has been described. [41, 42, 43] Once full myocardial recovery is demonstrated for at least 6 months, a weaning protocol of heart failure therapy can be considered. [39]


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