Peripartum Cardiomyopathy

• related: Cardiology

• population:
  • age > 30
  • multiple gestation
  • preeclampsia
  • happens between 36 weeks gestation and 5 months postpartum
• symptoms: heart failure sx
• diagnosis: LVEF <45%, and no other cause of heart failure (ie, diagnosis of exclusion)
• treatment: treat systolic heart failure. Patients who develop PPCM during pregnancy are delivered based on maternal stability.
• after delivery:
  • Some patients will have spontaneous resolution of ventricular dysfunction and can discontinue their medication regimen
  • risk of recurrence high with patients with LVEF <20% at diagnosis
  • Patients with persistent PPCM are at risk for further LV function decline and death in subsequent pregnancies.
  • Therefore, regardless of PPCM resolution, patients are evaluated with serial echocardiograms for a few years. Those with recurrent or persistent LV dysfunction are advised to avoid pregnancy.