Peripartum Cardiomyopathy Treatment with Dopamine Agonist and Subsequent Pregnancy with a Satisfactory Outcome

Abstract

Pathophysiological mechanisms of peripartum cardiomyopathy are not yet completely defined, although there is a strong association with various factors that are already known, including pre-eclampsia. Peripartum cardiomyopathy treatment follows the same recommendations as heart failure with systolic dysfunction. Clinical and experimental studies suggest that products of prolactin degradation can induce this cardiomyopathy. The pharmacological suppression of prolactin production by D2 dopamine receptor agonists bromocriptine and cabergoline has demonstrated satisfactory results in the therapeutic response to the treatment. Here we present a case of an adolescent patient in her first gestation with peripartum cardiomyopathy that evolved to the normalized left ventricular function after cabergoline administration, which was used as an adjuvant in cardiac dysfunction treatment. Subsequently, despite a short interval between pregnancies, the patient exhibited satisfactory progress throughout the entire gestation or puerperium in a new pregnancy without any cardiac alterations. Dopamine agonists that are orally used and are affordable in most tertiary centers, particularly in developing countries, should be considered when treating peripartum cardiomyopathy cases.

Prolactin and Autoimmunity

“…Interestingly, patients demonstrated an abnormal cytokine profile (increased levels of TNF, IL-6 and soluble Fas receptors), decreased levels of CD4+ CD25lo Tregs, a heightened level of fetal microchimerism, and a significant reduction in the plasma levels of progesterone, estradiol, and relaxin, contributing to abnormal immune responses and inflammatory processes ( 120 , 121 ). Recently, dopamine agonists have shown promising results in the treatment of this disease, dramatically improving outcomes ( 58 , 122 – 124 ). The 2010 European position statement does not encourage breastfeeding based on concerns regarding the perpetuation of PRL pathways ( 125 ).…”

Posicionamento da Sociedade Brasileira de Cardiologia para Gravidez e Planejamento Familiar na Mulher Portadora de Cardiopatia – 2020

“…205,206 MicroRNA-146a is a highly specific marker for the diagnosis of CMPP 207 Prolactin blockade by bromocriptine or cabergoline, a dopamine-D2 receptor agonist, has shown promising results in therapy and recovery of myocardial function in PPCM. [207][208][209][210][211] The main risk factors for PPCM are hypertensive pregnancy syndromes 212 (gestational hypertension, preeclampsia, eclampsia or HELLP syndrome), chronic hypertension, multiple pregnancies, obesity, smoking, pre-diabetes and diabetes mellitus, advanced age or adolescence and prolonged use of beta agonists. 213 Mortality rates may be lower than 5%, or they may be as high as 50% of cases.…”

Cabergoline treatment promotes myocardial recovery in peripartum cardiomyopathy

“…Our data are supported by promising results in several single case reports of PPCM patients treated with cabergoline, showing similar positive effects on the clinical course without the occurrence of adverse events. 26 , 27 , 28 , 29 Furthermore, in a retrospective study including 24 Danish PPCM patients treated with cabergoline, the treatment was associated with an increased chance of full cardiac recovery, 30 further emphasizing the positive effects of cabergoline treatment in PPCM patients regarding the cardiac outcome.…”