Peripartum Cardiomyopathy

Peripartum Cardiomyopathy (PPCM)

• Usually develops in last month of pregnancy or first 5 months post-delivery.

• Presents as heart failure with reduced ejection fraction (dilated cardiomyopathy)

↳ LV EF < 45%

• PPCM is a diagnosis of exclusion.

• Risk factors →

1- History of Hypertension, Pre-eclampsia

2- Black women

• Incidence → 1 in 2000 live births.

• Management →

1. Guideline directed medical therapy for HF-
Beta-blockers
Hydralazine plus isosorbide dinitrate

Diuretics

2. Bromocriptine

3. Low threshold for anticoagulation

4. ACE inhibitors and ARBs are contraindicated before delivery.

5. Safety of ARNI and SALT-2 inhibitors in not clear at present.

• Mode of delivery: Vaginal delivery is preferred.

• If LV dysfunction persists, avoid future pregnancies.

• Prognosis →

1. About half of the patients will recover.

2. And half will have some degree of LV dysfunction.

3. Approximately 25% of patients with LV dysfunction will have moderate to severe LV dysfunction.

• Fett probability scoring → For diagnosis of PPCM

High heart rate

The patient contacts the doctor over phone with this report. Obviously anxious because of his high heart rate (199 beats per minute) as detected by ECG machine. Should he be worried about this and come to emergency department as soon as possible? Correct answer- ECG machine has calculated his heart rate incorrectly. Heart rate is around 100 beats per minute. Other findings in this ECG include ST segment elevation in anterior chest leads along with presence of Q waves, denoting old MI changes with possibly development of LV aneurysm. In such cases, ST segment elevation can persist for long periods. Now, should he come to emergency department? Not because of detection of high heart rate. But, if he is having symptoms such as shortness of breath or chest pain, he should visit emergency department. Otherwise, if he is asymptomatic, he can schedule a regular visit with his cardiologist.

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