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