What Is Peripartum Cardiomyopathy?

Overview

Peripartum cardiomyopathy is a potentially life-threatening disease associated with pregnancy.  It typically arises in the peripartum period, usually in the final month of pregnancy or sometimes, right after childbirth. It occurs without any identifiable cardiac cause. The disease is rare but it’s a rising incidence. It is an idiopathic form of cardiomyopathy. In cardiomyopathy, heart muscles become weak, especially the left ventricle muscles. Patients can present with left ventricular dysfunction, in which the ventricles dilate and the ejection fraction percentage reduces to as low as 45%. Ejection fraction is the amount of blood the heart pumps out with every beat. Hence, the ineffective transport of blood throughout the body can have detrimental consequences.¹

Causes of peripartum cardiomyopathy

Although peripartum cardiomyopathy is idiopathic, there are several risk factors disposing patients to peripartum cardiomyopathy:¹

• Long-term hypertension
• Obesity
• Multiple gestations
• Alcoholism
• Drug abuse
• Diabetes
• Heart valve disease
• Thyroid disease
• Build up of iron in heart muscles
• Older age
• Family history
• Heart disease

Signs and symptoms of peripartum cardiomyopathy

There are no symptoms that are unique to peripartum cardiomyopathy as symptoms resemble those that manifest in other cardiovascular conditions, such as heart failure. These include:²

• Irregular heartbeat
• Palpitations
• Fatigue
• Shortness of breath with or without physical activity
• Bloating 
• Chest discomfort
• Dry cough 
• Nocturia

Management and treatment for peripartum cardiomyopathy

Peripartum cardiomyopathy can be fatal, so it is imperative that treatment is initiated as soon as a diagnosis has been made. Treatment is needed to manage the signs and symptoms that a patient presents with, preventing the condition from getting worse. Medication is also useful in reducing the risk of complications, such as a heart attack.

The type of treatment depends on its type and the severity of the cardiomyopathy. Your physician may prescribe medications according to the ESC guidelines for heart failure:

If peripartum cardiomyopathy occurs late in pregnancy, then therapeutic interventions need to consider the health of both the child-bearing parent and the child. The medications given can include:

• Beta-blockers
• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin receptor blockers
• Calcium channel blockers
• Thiazide diuretics (the lowest thiazide dose should be used as it impairs perfusion of the placenta)

After delivery, the standard therapy for heart failure is used in patients with peripartum myocardiopathy. These include beta-blockers, ACE inhibitors, angiotensin receptor blockers mineralocorticoid receptor antagonists (MRA), and diuretics. Anticoagulants, antiarrhythmic drugs and digoxin can be prescribed as well.²  

Diagnosis of peripartum cardiomyopathy

Your doctor will perform a physical examination and take a detailed family and medical history, asking about your symptoms. Your doctor will also use several diagnostic tests to confirm the diagnosis:³

• Echocardiograms can detect cardiomyopathy by assessing the function of the heart and checking the heartbeat
• Cardiac MRI can analyse ventricle contractions and reveal ischemic heart disease or acute myocarditis as alternate diagnoses
• Cardiac CT scan evaluates the heart and surrounding blood vessels to identify any blockages of the arteries and to detect any problems with the pumping function of the heart
• Blood tests can be done to show the level of brain natriuretic peptide (BNP) in your body, which is typically elevated in peripartum cardiomyopathy
• X-ray to look for signs of heart failure

Risk factors

The probability of suffering from peripartum cardiomyopathy can increase based on some factors:⁴

• Family history
• Chemotherapy drugs or radiation
• Amyloidosis
• Sarcoidosis
• Connective tissue disorder

Complications

Peripartum cardiomyopathy can lead to serious complications, such as heart failure, blood clot formation and heart attack, which can all result in sudden death.

FAQs

How can I prevent peripartum cardiomyopathy?

You can prevent peripartum cardiomyopathy through lifestyle modifications:

• Eat a healthy diet (fruits and vegetables)
• Eat lean meat, fish, and low-fat milk
• Lower your salt intake
• Lose excess weight and maintain a healthy weight
• Regular exercise (after consulting physicians)
• Taking all prescribed medicine
• Avoid alcohol
• Avoid substance abuse

How common is peripartum cardiomyopathy?

It is a rare condition but its incidence is on the rise. The incidence rate varies in different countries. It is approximated to occur in the child-bearing parent in every 1 out of 4,000 live births.⁵

When should I see a doctor?

You should become concerned with your condition If you have swollen legs and feet well after delivery or if you are experiencing shortness of breath. These can be early symptoms of peripartum cardiomyopathy because fluid starts to accumulate in the legs, the feet, and the lungs when the heart is not working properly.

Is it safe for a peripartum cardiomyopathic patient to have another pregnancy?

It depends on the individual’s health and the degree to which they have recovered from their cardiomyopathy. 

Summary

Peripartum cardiomyopathy is an idiopathic disease that occurs during the gestational period or immediately after childbirth. When the child-bearing parent develops this disease, the left ventricle of the heart dilates. The incidence rate of the disease is on the rise and yet, its pathophysiology and symptoms are still poorly defined. It is a severe form of cardiomyopathy and the leading cause of death for patients. There are some diagnostic tests to differentiate peripartum cardiomyopathy from other cardiopathies, like a brain natriuretic peptide (BNP) blood test, an echocardiogram, a cardiac CT scan, and an MRI. The preferred treatments are beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers and diuretics. It is important to diagnose peripartum cardiomyopathy early so that fatal complications, like heart attack and heart failure, are prevented.