Related Subjects:
| Dilated Cardiomyopathy
| Hypertrophic Cardiomyopathy (HCM - HOCM)
| Peripartum Cardiomyopathy
| Restrictive Cardiomyopathy
| Takotsubo Cardiomyopathy
Peripartum cardiomyopathy is a serious condition that requires prompt diagnosis and management to improve outcomes. With early intervention and appropriate treatment, many women can recover cardiac function, but long-term follow-up is essential.
Peripartum Cardiomyopathy |
- A cause of dyspnoea in late pregnancy and the early postpartum period.
- Exclude other causes like venous thromboembolism (VTE)/pulmonary embolism (PE) and pneumonia. Suspect left ventricular failure due to peripartum cardiomyopathy.
- Initial management includes ABCs, diuretics, and oxygen if there is pulmonary congestion. Consult obstetricians if the patient is still pregnant.
- Anticoagulation may be required. Use IV heparin if still pregnant; consult specialists for further advice.
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About
- Typically occurs in the last month of pregnancy or within five months after delivery.
- Characterized by progressive dyspnoea, heart failure
- Left ventricular systolic dysfunction with an ejection fraction (EF) < 45%.
Higher Risks
- Maternal age ≥ 30 years
- Multiparity (having multiple pregnancies)
- African descent
- Pregnancy with multiple fetuses
- History of preeclampsia, eclampsia, or postpartum hypertension
- Maternal cocaine use
- Long-term use (>4 weeks) of oral tocolytic therapy with beta-adrenergic agonists (e.g., terbutaline)
Clinical Features
- Breathlessness and fatigue
- Ankle oedema
- Palpitations and arrhythmias
- Cardioembolic events
Investigations
- FBC, U&E, LFT, CRP, and ECG: Routine blood tests and ECG help in initial evaluation.
- CXR: Shows cardiomegaly, pleural effusion, or pulmonary oedema. CXR is safe during pregnancy as it involves minimal radiation.
- Echocardiogram: Key diagnostic tool. It typically shows a reduced ejection fraction (< 45%) and may show left ventricular dilation.
- BNP or NT-proBNP: Elevated levels indicate heart failure.
- Cardiac biomarkers (e.g., troponins): May be mildly elevated.
- Cardiac MRI: Used to assess myocardial function and exclude other causes of cardiomyopathy.
- Coronary angiogram: May be needed to exclude ischaemic heart disease (IHD) in some cases.
Management
- ABCs: Prioritize airway, breathing, and circulation. Use diuretics and oxygen as needed.
- Anticoagulation: Consider for patients with severe left ventricular dysfunction (EF < 35%) to prevent thromboembolic events.
- Medication: Manage like any other cause of heart failure, but avoid ACE inhibitors (ACEI) and angiotensin receptor blockers (ARBs) during pregnancy due to fetal risk.
- Supportive care: May involve inotropes, intra-aortic balloon pumping, or even cardiac transplant in severe cases.
- Future pregnancies: There is a high risk of recurrence, so sterilization or contraception should be discussed.
- The exact aetiology is unknown, but deficiencies in selenium or other trace elements may play a role.
Pregnancy-Specific Care
- Delivery: Vaginal delivery is generally safer than Caesarean section, as it carries a lower risk of PE and endometritis.
- Preeclampsia: Always exclude preeclampsia in these patients.
- Anticoagulation: IV heparin is preferred over low-molecular-weight heparin (LMWH) due to better control.
- Avoid ACE inhibitors and ARBs: These medications can cause fetal anomalies; instead, use hydralazine and nitrates as alternatives, along with beta-blockers.
- Neonatal care: Ensure access to neonatal intensive care if needed.