Makindo Medical Notes.com

Related Subjects: |Dilated Cardiomyopathy |Hypertrophic cardiomyopathy (HCM - HOCM) |Peripartum cardiomyopathy |Restrictive Cardiomyopathy |Takotsubo Cardiomyopathy

Peripartum cardiomyopathy is a serious condition that requires prompt diagnosis and management to improve outcomes. With early intervention and appropriate treatment, many women can recover cardiac function, but long-term follow-up is essential.

About

• Occurs in the Last month of pregnancy and first five months after delivery
• Progressive dyspnoea, heart failure and LV systolic dysfunction EF < 45%

Higher Risks

• Age ≥ 30 years, Multiparity, African descent
• Pregnancy with multiple fetuses
• A history of preeclampsia, eclampsia, or postpartum hypertension
• Maternal cocaine abuse
• Long term (>4 weeks) oral tocolytic therapy with beta-adrenergic agonists such as terbutaline

Clinical

• Breathlessness, Fatigue, Ankle oedema
• Palpitations, Arrhythmias
• Cardioembolic phenomena

Investigations

• FBC U&E LFTs, CRP, ECG
• CXR: cardiomegaly, effusion, pulmonary oedema (CXR is safe as very little radiation indeed)
• Echocardiogram: typically shows a reduced ejection fraction (EF) of less than 45%, indicating systolic dysfunction. Dilatation of the left ventricle may also be seen.
• Brain Natriuretic Peptide (BNP) or NT-proBNP: Elevated levels indicate heart failure.
• Cardiac Biomarkers: Troponin levels may be mildly elevated.
• Cardiac MRI is used in some cases to assess myocardial function and to rule out other causes of cardiomyopathy.
• May need a Coronary angiogram to exclude IHD

Management

• ABCs, Diuretics. Oxygen. Anticoagulation may be considered with severe left ventricular dysfunction (EF < 35%) to prevent thromboembolic events.
• Treated like any other cause of cardiac failure but certain drugs should be avoided e.g. ACE/ARB's until post partum
• Management is largely supportive and may involve inotropes or Intra-aortic balloon pumping and cardiac transplant in severe cases
• There is a high risk of recurrence with future pregnancies so consider sterilisation and contraception should be considered.
• Aetiology is unknown and deficiencies in selenium or other trace elements may be relevant

General advice on medical care of this if she had been pregnant

• Vaginal delivery appears to be safer than C/Section with less PE and endometritis
• Exclude preeclampsia
• Use IV Heparin rather than LMWH as more control
• Avoid ACEI and ARB's as they can cause fetal anomalies
• Use Hydralazine and Nitrates instead and Beta-blockers
• Access to neonatal ITU