Peripartum Cardiomyopathy
From Ask Dr Wiki
Contents |
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
