Peripartum cardiomyopathy, diagnostic challenge

Abstract

Peripartum cardiomyopathy is a disorder that presents clinically as a heart failure syndrome in women in the peripartum period. Prolactin plays a fundamental role in its pathophysiology along with a genetic basis that predisposes to the development of the disease. For its diagnosis it is necessary to meet three criteria, which develops in the last month of pregnancy or 5 months postpartum, absence of another cause of signs and symptoms along with LV dysfunction. As for diagnostic tests, echocardiography is essential since it confirms part of the diagnostic criteria and rules out some differential diagnoses. After confirming the diagnosis, a stratification of the severity of the patient should be performed, because it can be a life-threatening pathology due to cardiogenic shock, arrhythmias, or complications such as embolism due to cavitary thrombi. Management is similar to any other acute heart failure and when stabilization is achieved, treatments should be initiated according to guidelines for heart failure, this taking into account the drugs contraindicated in pregnancy: ACE inhibitor,  ARA II,  ARNI, MRA, and atenolol. In addition, the decision of the time and way to end the pregnancy must be made; In general, it is recommended to terminate the pregnancy because it acts as an increase in cardiac output, cesarean section is preferred in patients in shock and vaginal delivery when there is stability.  To the treatment for failure should be added in most patients bromocriptine, to inhibit the effects of prolactin, along with anticoagulation. The prognosis varies with a mortality of 2% to 12% at 6 months and 24 % at 24 months, may recur in subsequent pregnancies, however, they are safe with adequate follow-up and treatment, except in patients who did not recover EF in whom pregnancy is not recommended.