Overview of peripartum cardiomyopathy

Abstract

Peripartum cardiomyopathy is defined as: acute heart failure secondary to systolic dysfunction, occurring towards the end of pregnancy or in the first five months after delivery. It has an incidence of 1 in 1,000 to 1 in 4,000 births.

The most important risk factor is being of African descendence; other factors are advanced maternal age, multiparity and hypertensive disorders. The pathophysiology remains unknown, and autoimmune processes, inflammatory factors, acute infections, malnutrition, hormonal alterations, cellular apoptosis, endothelial dysfunction and oxidative stress have been proposed as the causes of the disease.

The clinical manifestations are varied and include fatigue, exertional dyspnea, paroxysmal nocturnal dyspnea, cough, orthopnea, edema with pitting, palpitations, chest pain, tachypnea, tachycardia, elevated jugular venous pressure, pulmonary rales, gallop rhythm and ascites. The diagnosis is of exclusion, and an echocardiogram, electrocardiogram, measurement of natriuretic peptides (BNP and NT pro-BNP), and chest X-ray should be requested.

Treatment is like other causes of heart failure and includes maintaining adequate oxygenation, fluid and salt restriction, and slowing the progression of left ventricular dysfunction. The drugs used are diuretics, vasodilators, inotropics, angiotensin converting enzyme inhibitors, angiotensin receptor II inhibitors, beta-blockers, digoxin, spironolactone and anticoagulation with heparin. Mortality is approximately 4%.