Peripartum Cardiomyopathy

Peripartum cardiomyopathy (PPCM) is defined as non-ischemic systolic dysfunction of the left ventricle (ejection fraction <45%) manifested towards the end of a pregnancy or in the early postpartum period when no other cause of heart failure is identified. The pathophysiology of PPCM seems to be related to complex interaction of genetic background with hormonal and vascular milieu of late pregnancy. Disease management should be tailored based on the hemodynamical status of the mother and the prognosis of the foetus within a multidisciplinary team. Importantly, PPCM patients with severe acute heart failure or cardiogenic shock should be transferred to centres with available mechanical circulatory support and scheduled for early delivery by a caesarean section. There are important differences in the pharmacotherapy of heart failure in the antepartum and postpartum periods. Preventive anticoagulation should be considered in left ventricular ejection fraction <35% and also during treatment with bromocriptine. Bromocriptine might be effective in severe forms of PPCM to facilitate left ventricular recovery. Women with PPCM considering a subsequent pregnancy should be counselled and monitored by physicians familiar with this disease.