Peripartum cardiomyopathy

Koenig, Tobias; Hilfiker‐Kleiner, Denise; Bauersachs, Johann

doi:10.1007/s00059-018-4709-z

Cited by 28 publications

(47 citation statements)

References 42 publications

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“…Impella) with or without ECMO [206] is recommended. Caesarean section is the preferred delivery method in unstable patients with PPCM [209]. In patients with persistently low EF < 35% despite optimal medical therapy, wearable cardioverter-defibrillator (WCD), implantable cardioverter-defibrillator (ICD), and possibly listing for heart transplantation should be considered.…”

Section: Peripartum Cardiomyopathymentioning

confidence: 99%

Management of hypertension in pregnancy — prevention, diagnosis, treatment and long-term prognosis. A position statement of the Polish Society of Hypertension, Polish Cardiac Society and Polish Society of Gynaecologists and Obstetricians

Prejbisz¹,

Dobrowolski²,

Kosiński³

et al. 2019

Arterial Hypertension

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Disclaimer: The position statement represent the views of the authors and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their dating. The authors and societies are not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the position statement and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the position statement fully into account when exercising their clinical judgment as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies. 118 www.ah.viamedica.pl ABPM -ambulatory blood pressure monitoring ACE-I -angiotensin-converting enzyme inhibitor AF -atrial fibrillation AFI -amniotic fluid index AFL -atrial flutter AGA -appropriate for gestational age AHI -apnea hypopnea index AKI -acute kidney injury ALT -alanine transaminase ARB -angiotensin receptor blocker ARR -aldosterone-to-renin ratio AST -aspartate aminotransferase AT -atrial tachycardia BAV -bicuspid aortic valve BMI -body mass index BNP -B-nariuretic peptide BP -blood pressure Bpm -beats per minute BPP -biophysical profile CABG -coronary artery bypass graft CAD -coronary artery disease CKD -chronic kidney disease CNS -central nervous system CoA -coarctation of the aorta CPAP -continuous positive airway pressure CPR -cerebroplacental ratio CTG -cardiotocography CV -cardiovascular DBP -diastolic blood pressure DIC -disseminated intravascular coagulation DM -diabetes mellitus ECMO -extracorporeal membrane oxygenation ECG -electrocardiography EF -ejection fraction ESC -European Society of Cardiology ESH -European Society of Hypertension EVA -early vascular ageing FDA -Food and Drug Administration FHR -foetal heart rate FIGO -International Federation of Gynaecology and Obstetrics FMD -fibromuscular dysplasia FMF -Fetal Medicine Foundation FPS -frame per second GFR -glomerular filtration rate HELLP -hemolysis, elevated liver enzymes, low platelet countuterine growth restriction IVF -in vitro fertilisation LBBB -left bundle branch block LBW -low birth weight LDH -lactate dehydrogenase LQTS -long QT syndrome LVAD -left ventricular assist device LVEF -left ventricular ejection fraction MAP -mean arterial pressure MCA -middle cerebral artery MCS -mechanical circulatory support MDT -multidisciplinary team MRA -mineralocorticoids renceptor antagonist MRAs -mineralocorticoids renceptor antagonists MRI -magnetic resonance imaging NSTEMI -non-ST elevation myocardial infarction NT-BNP -N-terminal pro-BNP NTS -non-stress-test OGTT -oral glucose tolerance test OSA -obstructive sleep apnoea p.o. -per os PA -primary aldosteronism PAPP-A -pregnancy associated placental protein PCI -percutaneous coronary intervention PE -pre-eclampsia PI -pulsatility index PlGF -placental growth factor PPCM -peripartum cardiomyopathy PPGL -pheochromocytoma a...

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Section: Peripartum Cardiomyopathymentioning

confidence: 99%

Management of hypertension in pregnancy — prevention, diagnosis, treatment and long-term prognosis. A position statement of the Polish Society of Hypertension, Polish Cardiac Society and Polish Society of Gynaecologists and Obstetricians

Prejbisz¹,

Dobrowolski²,

Kosiński³

et al. 2019

Arterial Hypertension

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“…Walau bagaimanapun, dehidrasi akibat diuretika dapat menyebabkan hipoperfusi uterus dan asidosis metabolik pada ibu, sehingga direkomendasikan hanya bila terjadi overload. [11][12][13] Reduksi afterload. Penggunaan vasodilator dapat mengganggu aliran darah uteroplasenter dan agen vasoaktif yang diberikan memerlukan pengawasan invasif.…”

Section: Manifestasi Klinisunclassified

“…7 Pada kasus dengan simptom gagal jantung yang persisten, valsartan dapat menggantikan penghambat ACE. 11 Hidralazin sebagai vasodilator dapat digunakan selama kehamilan, dan merupakan vasodilator utama antepartum. Pada kasus yang lebih berat, dapat diberikan penggunaan nitrogliserin dengan dosis 10-20 mcg/menit dan titrasi sampai 200 mcg/menit.…”

Section: Manifestasi Klinisunclassified

Kardiomiopati Peripartum: Manajemen Anestesi Terbaru

Septica¹,

Isngadi

2021

JAOI

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Kardiomiopati peripartum (KMPP) atau Peripartum cardiomyopathy (PPCM) adalah kelainan jantung idiopatik dengan karakteristik disfungsi sistolik dan simptom gagal jantung pada akhir masa kehamilan atau beberapa bulan setelah kehamilan tanpa sebab lain yang mengancam jiwa maternal dengan risiko morbiditas dan mortalitas postpartum cukup tinggi. Penelitian terbaru dalam pemahaman tentang patofisiologi PPCM menunjukkan proses yang melibatkan faktor endotel dan faktor toksik kardio, seperti sFlt-1 dan 16 kDa prolaktin, sehingga kemampuan jantung beradaptasi terhadap kehamilan normal terlampaui pada ibu yang sudah rentan terhadap serangan jantung. Terapi spesifik PPCM belum dapat ditentukan. Bromokriptin yang bekerja memblok pelepasan prolaktin dari glandula pituitaria, pada beberapa penelitian awal menghasilkan perbaikan fraksi ejeksi ventrikel kiri secara bermakna. Penelitian lebih lanjut dengan jumlah sampel yang lebih besar masih harus dilakukan untuk terapi ini. Prinsip manajemen direkomendasikan sesuai dengan patofisiologi yang terjadi. Optimalisasi atau reduksi preload baik dengan reduksi natrium maupun cairan dan penggunaan diuretika, menurunkan afterload dengan vasodilator, dan memperbaiki kontraktilitas jantung dengan inotropik, dromotropik, atau inodilator adalah strategi utama yang direkomendasikan. Tidak ada perubahan strategi dalam manajemen terapi ini, tetapi pilihan teknik anestesi saat ini lebih berkembang ke analgesi/anestesi regional. Pemahaman penggunaan dosis dan konsentrasi anestetika lokal menjadi penting untuk mencapai target dalam strategi yang direkomendasikan. Peripartum Cardiomyopathy: Update in Anesthesia Management Abstract Peripatum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy presenting with heart failure secondary to left ventricle systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause for heart failure is identified, life-threatening, and postpartum high morbidity and mortality risk. Recent studies in the understanding of PPCM pathophysiology indicate that there’s processes involving endothelial and cardio-toxic factors such as e.g. sFlt-1 and 16 kDa prolactin, leading the heart’s capacity to adapt to a normal pregnancy may be exceeded in some women already susceptible to cardiac insult. Spesific therapy for PPCM can not be determined. Bromocriptine that blocks the release of a hormone called prolactine from the pituitary gland in some preliminary studies improved left ventricular ejection fraction significantly. Further research with larger sample size remains to be done for this therapy. Management principles for PPCM are recommended in accordance with the pathophysiology. Depending on the volume status, preload has to be optimized by either fluid administration or sodium restriction and diuretics, decrease afterload using vasodilator, and improve contractility by using inotropic, dromotropic, or inodilator are the main strategies. There is no change in management strategy for PPCM, but regional analgesia/anesthesia preferably for now. Understanding the dose and concentration administration of local anesthethic drugs are important to achieve targets recommendation.

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“…Dotychczasowe próby były przeprowadzane tylko na myszach, a wynik stosowania samego VEGF nie dał oczekiwanych rezultatów. Dopiero leczenie VEGF w połączeniu z bromokryptyną okazało się zadowalające [12].…”

Section: Patogenezaunclassified

“…Dwa kluczowe badania, które muszą zostać wykonane przy podejrzeniu PPCM to echokardiografia oraz pomiar stężenia N-końcowego fragmentu propeptydu natriuretycznego typu B (NT-proBNP, N-terminal pro-B-type natriuretic peptide) lub peptydu natriuretycznego typu B (BNP, B-type natriuretic peptide). Jeśli frakcja wyrzutowa lewej komory (LVEF, left ventricular ejection fraction) wyniesie 45% lub mniej lub stężenie peptydów natriuretycznych będzie podwyższone, konieczne są dalsze badanie w kierunku PPCM [12]. Do badań przydatnych w postawieniu diagnozy należą: badanie radiologiczne klatki piersiowej (może pokazać powiększenie sylwetki serca, cechy zastoju w krążeniu małym i wysięku opłucnowego), elektrokardiografia (cechy przeciążenia lewej komory, niespecyficzne zmiany w odcinkach ST, wydłużony odstęp QT czy szerokie zespoły QRS).…”

Section: Diagnostyka Ppcmunclassified

Kardiomiopatia połogowa — wciąż niepoznana. Aktualny stan wiedzy

2019

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Peripartum cardiomyopathy (PPCM) is defined as idiopathic cardiomyopathy which occurs at the end of pregnancy or in the first few months after delivery, with symptoms of heart failure (HF) secondary to left ventricular dysfunction, and at the same time no other cause for this condition. The pathomechanism of the disease has not yet been fully understood, but it is probably based on the interaction of complex factors. The clinical course of PPCM varies from life-threatening acute heart failure to mild symptoms mimicking the symptoms typical of the perinatal period. In Europe, PPCM is a rare disease but there are areas of the world where it occurs in one in every 300 cases. The treatment of PPCM is similar to that of HF with reduced ejection fraction. However, it is important to exclude drugs with teratogenic effects during pregnancy. The inclusion of bromocriptine in PPCM therapy seems to be justified, and in some cases improves the prognosis.

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Peripartum cardiomyopathy

Cited by 28 publications

References 42 publications

Management of hypertension in pregnancy — prevention, diagnosis, treatment and long-term prognosis. A position statement of the Polish Society of Hypertension, Polish Cardiac Society and Polish Society of Gynaecologists and Obstetricians

Management of hypertension in pregnancy — prevention, diagnosis, treatment and long-term prognosis. A position statement of the Polish Society of Hypertension, Polish Cardiac Society and Polish Society of Gynaecologists and Obstetricians

Kardiomiopati Peripartum: Manajemen Anestesi Terbaru

Kardiomiopatia połogowa — wciąż niepoznana. Aktualny stan wiedzy

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