Peripartum Cardiomyopathy (PPCM)

Introduction

Peripartum Cardiomyopathy (PPCM) is a rare but serious form of heart failure that occurs during the last month of pregnancy or within five months after delivery. It is characterized by the weakening of the heart muscle, leading to reduced pumping efficiency and potential complications.

Causes and Risk Factors

While the exact cause of PPCM is unknown, several risk factors have been identified: - Genetic predisposition - Hypertension during pregnancy (preeclampsia, eclampsia) - Multiple pregnancies (twins, triplets, etc.) - Advanced maternal age (>30 years old) - Obesity - Viral infections - Autoimmune responses - Smoking and alcohol use

Symptoms

Symptoms of PPCM are often similar to those of other types of heart failure and include: - Shortness of breath - Swelling in the legs and feet - Fatigue and weakness - Rapid or irregular heartbeat - Reduced ability to exercise - Persistent cough (due to fluid buildup in the lungs)

Diagnosis

Diagnosis of PPCM involves several tests: - Echocardiogram (ECHO) – Assesses heart structure and function - Electrocardiogram (ECG) – Detects abnormal heart rhythms - Blood tests (BNP, NT-proBNP) – Measure heart failure markers - Cardiac MRI – Provides detailed images of the heart - Chest X-ray – Helps identify fluid buildup in the lungs

Treatment

Treatment focuses on improving heart function and managing symptoms: - Medications: - Beta-blockers (e.g., carvedilol, metoprolol) - Angiotensin-converting enzyme (ACE) inhibitors (contraindicated during pregnancy, but useful postpartum) - Diuretics to reduce fluid overload - Anticoagulants to prevent blood clots - Lifestyle modifications: - Low-salt diet - Fluid restriction - Avoiding heavy physical exertion - Advanced therapies (for severe cases): - Implantable cardioverter-defibrillator (ICD) - Heart transplant in extreme cases

Prognosis

Recovery rates vary. Many women regain normal heart function, while others develop persistent heart failure. Early diagnosis and treatment significantly improve outcomes.

Prevention

Although PPCM cannot always be prevented, managing risk factors (e.g., controlling blood pressure, maintaining a healthy lifestyle) can reduce the likelihood of developing the condition.

Source recommendations

1. American Heart Association Guidelines on Peripartum Cardiomyopathy

  1. https://www.heart.org/en/health-topics/cardiomyopathy/what-is-cardiomyopathy-in-adults/peripartum-cardiomyopathy-ppcm
  2. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
  3. https://www.heart.org/en/health-topics/cardiomyopathy/what-is-cardiomyopathy-in-adults
  4. https://www.ahajournals.org/doi/10.1161/circulationaha.115.020491
  5. https://newsroom.heart.org/news/ai-technology-improved-detection-of-heart-disease-during-and-after-pregnancy

2. European Society of Cardiology Guidelines on Cardiovascular Disease in Pregnancy

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Cardiovascular-Diseases-during-Pregnancy-Management-of
  2. https://pubmed.ncbi.nlm.nih.gov/30165544/
  3. https://www.escardio.org/static-file/Escardio/Guidelines/publications/PREGN%20Guidelines-Pregnancy-FT.pdf
  4. https://pubmed.ncbi.nlm.nih.gov/21873418/
  5. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000772

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