Peripartum cardiomyopathy: a review

Abstract

Peripartum cardiomyopathy is a form of idiopathic systolic heart failure which occurs during the end of pregnancy or the early post-partum in the absence of an identifiable etiology. The exact pathogenesis remains unknown, and the incidence is higher in African ancestry, multiparous and hypertensive women, or older maternal age. Delay in diagnosis is common, mainly because symptoms of heart failure mimic those of normal pregnancy. Echocardiography showing decreased myocardial function is at the center of the diagnosis. Management relies on the general guidelines of management of other forms of non-ischemic cardiomyopathy; however, special attention should be paid when choosing medications to ensure fetal safety. Outcomes can be variable and can range from complete recovery to persistent heart failure requiring transplant or even death. High rates of relapse with subsequent pregnancies can occur, especially with incomplete myocardial recovery. Additional research about the etiology, experimental drugs, prognosis, and duration of treatment after recovery are needed.

Tendência da mortalidade materna no Estado do Rio de Janeiro, Brasil, entre 2006 e 2018, segundo a classificação CID-MM

“…Esse diagnóstico vem sendo mais valorizado recentemente e constitui uma causa relativamente comum em alguns países 29 . Pode-se explicar, em parte, o elevado número encontrado no Rio de Janeiro, pela igualmente elevada frequência dos fatores associados às cardiomiopatias em nosso meio: descendência africana, diabetes, hipertensão e pré-eclâmpsia, tabagismo 29,30 . Além disso, o diagnóstico da doença na gravidez pode ser dificultado pela sobreposição de sintomas frequentes no final da gestação com os do agravo, o que acarreta prejuízo no tratamento precoce e aumento de complicações 29,30 .…”

“…Pode-se explicar, em parte, o elevado número encontrado no Rio de Janeiro, pela igualmente elevada frequência dos fatores associados às cardiomiopatias em nosso meio: descendência africana, diabetes, hipertensão e pré-eclâmpsia, tabagismo 29,30 . Além disso, o diagnóstico da doença na gravidez pode ser dificultado pela sobreposição de sintomas frequentes no final da gestação com os do agravo, o que acarreta prejuízo no tratamento precoce e aumento de complicações 29,30 . Por outro lado, pode estar havendo certa supernotificação, pela dificuldade no diagnóstico diferencial entre cardiomiopatia no puerpério e outros quadros cardiovasculares.…”

A Case of Postpartum Pulmonary Edema With Preserved Ejection Fraction and Diastolic Capacity

“…HFpEF is diagnosed when the patient develops clinical symptoms of heart failure, and when echocardiography shows preserved EF but impaired diastolic function [ 5 ]. Peripartum cardiomyopathy is generally diagnosed by EF falling to less than 45% [ 2 ], but in this case, EF was preserved, so the possibility of HFpEF was considered. However, since the diastolic function was normal, HFpEF was not diagnosed.…”

“…Perinatal cardiomyopathy is a rare condition in which a healthy woman develops left ventricular dysfunction and heart failure during the perinatal period [ 1 ]. Diagnostic criteria for perinatal cardiomyopathy include a decreased ejection fraction (EF) of less than 45% on echocardiography [ 2 ]. Recently, however, cases of peripartum cardiomyopathy have been reported in which EF is preserved but left ventricular diastolic dysfunction develops, resulting in heart failure [ 3 ].…”

Postpartum maternal tachycardia – diagnostic pitfalls!

“…It is most commonly diagnosed postpartum [3] but can occur at any time during pregnancy [17 ▪ ]. BNP and NT-Pro BNP levels correlate with clinical outcomes including recovery of LVEF [17 ▪ ,19 ▪ ].…”