Peripartum cardiomyopathy: A comprehensive review

Brown, Christopher; Bertolet, Barry D.

doi:10.1016/s0002-9378(98)80034-3

Cited by 100 publications

(118 citation statements)

References 26 publications

Supporting

Mentioning

103

Contrasting

Unclassified

Order By: Relevance

“…4 If supportive treatment fails, cardiac transplantation may be indicated. 5 The prognosis is related to the recovery of ventricular function. 4 The mortality rate of peripartum cardiomyopathy is 30-60% and may be caused by severe pulmonary congestion, and/or thromboembolic events.…”

Section: Discussionmentioning

confidence: 99%

Combined spinal-epidural anesthesia for Cesarean section in a patient with peripartum dilated cardiomyopathy

Shnaider¹,

Ezri²,

Szmuk³

et al. 2001

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose: To report a case of peripartum dilated cardiomyopathy associated with morbid obesity and possible difficult airway presenting for elective Cesarean section, which was successfully managed with combined spinal-epidural anesthesia.Clinical features: A morbidly obese parturient with a potentially difficult airway, suffering from idiopathic peripartum cardiomyopathy (ejection fraction 20%), was scheduled for an elective Cesarean section.A combined spinal epidural anesthesia was performed and 6 mg of bupivacaine were injected into the subarachnoid space. This was supplemented after 60 min with 25 mg of bupivacaine injected epidurally. The patient's hemodynamic status was monitored with direct intra-arterial blood pressure and central venous pressure measurements. The patient's perioperative course was uneventful. Conclusion:In patients suffering from peripartum cardiomyopathy, undergoing Cesarean section, combined spinal-epidural anesthesia may be an acceptable anesthetic alternative. ERIPARTUM cardiomyopathy occurs in approximately 1/10,000 deliveries 1 and can result in severe ventricular dysfunction during late pregnancy or early puerperium. 2 We present a patient with peripartum cardiomyopathy requiring Cesarean section (CS) who was managed with combined spinal-epidural (CSE) anesthesia.Case report A 25-yr-old, morbidly obese (weight 100 kg, height 1.58 m and body mass index 40) primigravida at 36 weeks gestation, with a Mallampati class IV airway, was scheduled for an elective CS. Two weeks before, she had complained of progressively worsening fatigue and dyspnea with minimal physical activity. A cardiology consultation obtained to evaluate progressively worsening fatigue led to the diagnosis of idiopathic dilated cardiomyopathy. Echocardiography revealed severe left ventricular dysfunction ejection fraction (EF) 20% with moderate pulmonary hypertension and moderate right ventricular dysfunction. Treatment with furosemide, digoxin, and potassium supplemen-OBSTETRICAL AND PEDIATRIC ANESTHESIA

show abstract

Section: Discussionmentioning

confidence: 99%

Combined spinal-epidural anesthesia for Cesarean section in a patient with peripartum dilated cardiomyopathy

Shnaider¹,

Ezri²,

Szmuk³

et al. 2001

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…Altre anomalie, seppur raramente presenti, sono ipertrofia ventricolare sinistra, onde T invertite, onda Q e alterazioni aspecifiche del tratto ST [117].…”

Section: Presentazione Clinica E Diagnosiunclassified

Peripartum Cardiomyopathy

Raddino

Bonadei

Teli

et al. 2016

Monaldi Arch Chest Dis

View full text Add to dashboard Cite

Monaldi Arch Chest Dis 2008; 70: 15-23 RASSEGNA IntroduzioneI primi autori che stabilirono una relazione tra scompenso cardiaco e puerperium furono Virchow [1], Ritchie [2] e Porak [3], alla fine del diciannovesimo secolo; tuttavia soltanto nel 1937, dopo che Gouley et al. [4] ebbero osservato gli aspetti clinici e patologici di sette pazienti gravide affette da scompenso cardiaco severo e spesso fatale, tale associazione iniziò ad essere descritta come entità clinica distinta. Le donne presentarono sia negli ultimi mesi di gravidanza sia durante il postpartum una cardiomiopatia dilatativa non ischemica; quattro delle sette pazienti decedettero; l'autopsia mostrò la dilatazione miocardica associata alla presenza di diverse aree necrotiche e fibrotiche molto estese, reperti comunque atipici se paragonati a quelli di altri pazienti con diagnosi di scompenso cardiaco. Per tale motivo gli autori proposero l'esistenza di una relazione, diretta o indiretta, tra scompenso cardiaco, gravidanza e/o puerperium. Analoga associazione fu poi descritta nel 1938 da Hull et al. in 80 pazienti di New Orleans [5], e negli anni successivi diversi autori coniarono i termini di scompenso cardiaco tossico post-partum, malattia cardiaca post-partum, miocardite post-partum, sindrome di Meadow, degenerazione miocardica idiopatica associata a gravidanza, sindrome Zaria e cardiomiopatia post-partum [6][7][8][9][10]. Nel 1971 Demakis et al. [11], in uno studio retrospettivo, descrissero la storia naturale di 27 pazienti con cardiomiopatia associata a gravidanza nel periodo 1947-1967 e definirono tale condizione Cardiomiopatia Peripartum (CMPP), stabilendone i criteri diagnostici, confermati poi durante la Workshop del National Heart, Lung, and Blood Institute (NHLBI) e dell'Office of Rare Diseases of the National Institutes of Health (NIH) nel 2000 [12]: a) scompenso cardiaco insorto nell'ultimo mese di gravidanza o nei 5 mesi dal parto; b) non disfunzione cardiaca preesistente; c) assenza di cause determinanti cardiomiopatia; più recentemente d) disfunzione sistolica ventricolare sinistra dimostrata ecocardiograficamente con frazione di eiezione (FE) < 45% e/o fractional shortening in M-mode < 30% con dimensione telediastolica > 2.7 cm/m 2 [13][14][15]. Nonostante i classici criteri per la definizione della CMPP di Demakis et al. limitassero la diagnosi all'ultimo mese gestazionale e ai primi 5 mesi dal parto, diversi articoli pubblicati successivamente descrissero donne con cardiomiopatia più precoce nel corso della gravidanza [16][17][18][19][20][21]. Infine Elkayam et al., presentando un'ampia casistica di pazienti affette da CMPP, suggerirono il cambiamento dei criteri "classici" dopo aver osservato che sia la presentazione clinica che l'outcome delle pazienti con cardiomiopatia associata alla gravidanza diagnosticata più precocemente rispetto all'ultimo mese di gestazione erano simili a quelle della CMPP "classica", concludendo quindi che entrambe le condizioni potessero rappresentare un continuum della stessa patologia [22]. C...

show abstract

“…3 Peripartum cardiomyopathy is more prevalent in older multiparous patients of African descent who have multiple gestations, chronic hypertension or preeclampsia, and have received prolonged tocolytic therapy. 2,4 There are four principal diagnostic features of PPCM: the development of heart failure in the last month of pregnancy or within five months of delivery; absence of an identifiable cause; absence of underlying heart disease prior to the last month of pregnancy; and evidence of left ventricular systolic dysfunction. 5 Recently, echocardiographic criteria were established, including an ejection fraction \ 45% and an end-diastolic dimension [ 2.72 cmÁm -2 .…”

mentioning

confidence: 99%

“…Severe cases may require mechanical support and consideration for heart transplantation. 3,4 Delivery of the fetus is usually indicated when the cardiac failure is intractable. 3 In this month's edition of the Journal, Ituk et al 7 report on the peripartum anesthetic management and outcomes of 25 women with dilated cardiomyopathy -four of whom were designated as having PPCM.…”

mentioning

confidence: 99%

“…3 La prévalence de la cardiomyopathie du péripartum est plus élevée chez les femmes multipares d'origine africaine qui ont eu des grossesses multiples, une hypertension chronique ou une prééclampsie, et qui ont reçu un traitement tocolytique prolongé. 2,4 La CMPP présente quatre caractéristiques diagnostiques principales: l'apparition d'une insuffisance cardiaque au cours du dernier mois de la grossesse ou dans les cinq mois suivant l'accouchement, l'absence de cause identifiable, l'absence de maladie cardiaque sous-jacente avant le dernier mois de la grossesse, et des signes de dysfonction systolique ventriculaire gauche. 5 Des critères échocardiographiques ont été récemment définis; ils incluent notamment une fraction d'éjection \ 45 % et une dimension de fin de diastole[2,72 cmÁm -2 .…”

unclassified

See 1 more Smart Citation

The peripartum anesthesiologist

Munro

George

2014

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

The association between pregnancy and cardiomyopathy has been evident since 1870. 1 Moreover, the incidence of peripartum cardiomyopathy (PPCM) is thought to range from 1 in 2,400 to 1 in 15,000 pregnancies; 2 however, a more recent review suggests an incidence of one in 3,000 to 4,000 pregnancies in western countries. 3 Peripartum cardiomyopathy is more prevalent in older multiparous patients of African descent who have multiple gestations, chronic hypertension or preeclampsia, and have received prolonged tocolytic therapy. 2,4 There are four principal diagnostic features of PPCM: the development of heart failure in the last month of pregnancy or within five months of delivery; absence of an identifiable cause; absence of underlying heart disease prior to the last month of pregnancy; and evidence of left ventricular systolic dysfunction. 5 Recently, echocardiographic criteria were established, including an ejection fraction \ 45% and an end-diastolic dimension [ 2.72 cmÁm -2 . 6 Basic principal treatment of PPCM includes a reduction of both preload and afterload along with the administration of inotropic therapy. Severe cases may require mechanical support and consideration for heart transplantation. 3,4 Delivery of the fetus is usually indicated when the cardiac failure is intractable. 3 In this month's edition of the Journal, Ituk et al. 7 report on the peripartum anesthetic management and outcomes of 25 women with dilated cardiomyopathy -four of whom were designated as having PPCM. With an average age of 32 and a history of hypertension and diabetes, these patients represent a higher risk group than the overall obstetrical population, which is in keeping with previous reports of PPCM risk factors. 5 This challenging group of patients was optimally managed by a multidisciplinary team with a distinct knowledge of peripartum care -a team that followed their patients' clinical progress at regular multidisciplinary case conferences.Fetal delivery in PPCM is dictated by the obstetric indications and occurs in consultation with the anesthesia team. Vaginal delivery offers minimal blood loss, hemodynamic stability, and avoidance of additional Cesarean delivery-related surgical stresses with an overall reduced chance of postoperative complications. Regional anesthesia is advantageous for reducing preload and afterload and minimizing the fluctuations in cardiac output associated with labour. Cesarean delivery is best reserved for indications such as breech presentation, fetal distress, or failure to progress. 8 Prognostic information of PPCM is limited and often confounded by the inclusion of patients with heart failure of differing etiologies. The reported mortality ranges from 18-50% 2 and it increases as a function of age, ejection fraction \ 25%, multiparity, African American ethnicity, and delayed diagnosis. 9 The recurrence rate of 50-100% 2 is influenced by the severity of PPCM during the index pregnancy and by left ventricular systolic function at the beginning of pregnancy. 10 Echocardiography may be helpful ...

show abstract

Peripartum cardiomyopathy: A comprehensive review

Cited by 100 publications

References 26 publications

Combined spinal-epidural anesthesia for Cesarean section in a patient with peripartum dilated cardiomyopathy

Combined spinal-epidural anesthesia for Cesarean section in a patient with peripartum dilated cardiomyopathy

Peripartum Cardiomyopathy

The peripartum anesthesiologist

Contact Info

Product

Resources

About