Peripartum Cardiomyopathy
Development of cardiac failure:
This covers peripartum cardiomyopathy. Management of cardiac disease in pregnancy is covered under Cardiac Disease in Pregnancy.
- Between the last month of pregnancy and five months postpartum
- In absence of:
- Identifiable cause, or
- Cardiac disease prior to the last month of pregnancy
- As defined by LV dysfunction on echo
With:- LVEF <45%, or
- Fractional shortening <30%
- +/- LVEDD >2.7cm/m2
Epidemiology and Risk Factors
Incidence:
- ~1:5,000-10,000
Risk Factors:
- Multiple Pregnancy
- Multiparity
- ↑ Maternal age
- Hypertension
- Black race
- Drug use:
- Sympathomimetics
- Tocolytics
- Cocaine
Pathophysiology
Aetiology
Clinical Manifestations
Features:
- Similarly to other cardiac failures
- Wheeze may be misdiagnosed as asthma
Diagnostic Approach and DDx
Investigations
- Echocardiography
Management
Anaesthetic Considerations
Marginal and Ineffective Therapies
Complications
Prognosis
Recovery:
- 30-50% will recover normal LV function
- Better recovery if LVEF is >30% at diagnosis
- Dobutamine stress test correlates with liklihood of recovery
Subsequent pregnancy:
- Associated with significant morbidity
Generally better than the pregnancy with the cardiomyopathy however:- 25% develop cardiac failure
- 15% have a fall in EF
10% have a persistent reduction in EF. - 13% premature birth rate