Peripartum Cardiomyopathy

  • population:
    • age > 30
    • multiple gestation
    • preeclampsia
    • happens between 36 weeks gestation and 5 months postpartum
  • symptoms: heart failure sx
  • diagnosis: LVEF <45%, and no other cause of heart failure (ie, diagnosis of exclusion)
  • treatment: treat systolic heart failure. Patients who develop PPCM during pregnancy are delivered based on maternal stability.
  • after delivery:
    • Some patients will have spontaneous resolution of ventricular dysfunction and can discontinue their medication regimen
    • risk of recurrence high with patients with LVEF <20% at diagnosis
    • Patients with persistent PPCM are at risk for further LV function decline and death in subsequent pregnancies.
    • Therefore, regardless of PPCM resolution, patients are evaluated with serial echocardiograms for a few years. Those with recurrent or persistent LV dysfunction are advised to avoid pregnancy.