Peripartum Cardiomyopathy

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Diagnostic criteria (Demakis et al, 1971)

  • Development of CHF/LV dysfunction in last month of pregnancy to 5 months postpartum
  • Absence of determinable cause
  • Absence of demonstrable cardiac disease before last month of pregnancy

Common Mimickers

  • Accelerated HTN
  • Infection/sepsis
  • Diastolic dysfunction
  • High output state of pregnancy

Demographics

  • Estimates of incidence 1/1300-15000
  • Previous studies likely overestimated
  • More common in women with:
  • Multiple pregnancies
  • African decent
  • h/o toxemia
  • Long-term tocolytic use
  • Age>30
  • Twin Pregnancy
  • Etiology remains unknown
  • Signs and sxs similar to those of nl pregnancy


Hemodynamic findings

Chamber Normal Pregnancy Peripartum CMP
RA 2 11 (2-34)
PA 11 39 (18-62)
PCW 6 18 (5-32)
CO (L/min) 7 6 (5-9)
HR 83 104 (76-142)

Treatment of Peripartum CMP

  • Digoxin and diuretics are Class C
  • ACE-inhibitors absolutely contraindicated prepartum (hydralazine drug of choice)
  • Anticoagulation recommended (Heparin prepartum and coumadin postpartum)


Outcome of Peripartum CMP

  • Mortality 25-50% (half deaths in first 3 months)
  • Remainder stable/recover within 6 months
  • Can recur with subsequent pregnancies
  • Favorable outcomes with cardiac transplantation
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