Peripartum cardiomyopathy

Abstract

Peripartum cardiomyopathy (PPCM) is a form of systolic heart failure (HF) with reduced left ventricular ejection fraction (LVEF) that affects women of childbearing age during pregnancy or in the early postpartum period. Delays in diagnosis may occur because the symptoms and signs of PPCM may mimic the normal findings of late pregnancy and the peripartum period. Although some women have relatively mild illness and full recovery, others experience significant morbidity and mortality. Although the condition is prevalent worldwide, women of black descent appear to be at higher risk, and the condition has a particularly high incidence in Nigeria and Haiti. Other risk factors include preeclampsia, advanced maternal age, and multiple gestation pregnancy. Although the full pathophysiology of PPCM remains unclear, research over the past decade suggests the importance of vascular-hormonal pathways in women with underlying susceptibility. At least some women with the condition harbor an underlying genetic mutation of the sarcomere. More than half of affected women recover systolic function, although some remain with chronic cardiomyopathy and a minority require mechanical support or cardiac transplantation (or both). Other possible complications include thromboembolism and arrhythmia. Management currently involves treatment for heart failure with reduced ejection fraction, with attention to minimizing possible adverse effects on the fetus in women who are still pregnant or nursing. Bromocriptine is a potential disease-specific treatment that is under investigation. This review will describe the classification, risk factors, etiology, pathophysiology, prognostic factors, diagnosis, treatment, and counseling.