Peripartum cardiomyopathy — a cardiovascular disease in pregnancy and puerperium. The actual state of knowledge, challenges, and perspectives

Abstract

Peripartum cardiomyopathy (PPCM) is an idiopathic, multifactor cause of heart failure occurring at the end of pregnancy or in the first months after delivery. Although the prevalence of the disease is increasing, the awareness of both physicians and patients is rather low. Symptoms of PPCM are unspecific, making a prompt diagnosis even more difficult. In severe functional insufficiency and dilatation of the left ventricle, the recovery rate is particularly low. Therefore, the later PPCM is diagnosed, the more severe heart failure, and the worse the patient’s outcome. Despite the increasing frequency of PPCM, the exact pathophysiology and predictors of outcome are still not well determined. Therapeutic management in patients with PPCM remains a challenge, requiring a multidisciplinary approach. At the base of the disease lies dysfunction of microcirculation with 16-kDa prolactin as the main trigger of this state. Therefore, adding bromocriptine to standard heart failure pharmacotherapy may be particularly beneficial. In this review, we present the current state of knowledge and diagnostic and management recommendations and perspectives.