Peripartum Cardiomyopathy: An Update

Peripartum cardiomyopathy (PPCM) is heart failure that develops in the last months of pregnancy or up to 5 months postpartum with left ventricular systolic dysfunction. Most common in Nigeria, which is related to micronutrient deficiency and high salt intake. The general risk for PPCM varies from hypertension to smoking. Pregnancy related-factors from advanced maternal age to preeclampsia. Etiological factors are genetic, autoimmune, malnutrition, inflammation, angiogenic imbalance due to hormonal changes. Diagnosis is by the exclusion of frequent causes of heart failure, occurrence in the last months of pregnancy, or up to 5 months without any other cardiac disease. The echocardiogram will show a reduced left ventricular ejection fraction of less than 45%. Treatment of PPCM in acute settings is oxygen supplementation, diuretics, vasodilators, and anticoagulation. If the patient presents in shock, they may have to resuscitate with vasopressors and inotropes. Long-term treatment includes lifestyle changes, diuretics, beta-blockers, anticoagulation, and heart transplants. Delivery of the fetus was not reported to improve PPCM. 50% of patients recover in 6 months, 25% have persistent symptoms, and 25% develop complications. Maternal mortality rates range from 4% to 11%. Women with PPCM should be counseled for contraception and subsequent pregnancies. Those patients with recovered left ventricular ejection fraction seem to have minor changes with favorable maternal and fetal outcome.