Peripartum Cardiomyopathy: Facts and Figures

Abstract

Peripartum cardiomyopathy (PPCM) is a rare clinical entity during pregnancy. PPCM is a diagnosis of exclusion. These patients do not have prior history of heart disease, and there are no other known possible causes of heart failure. It is more common in African countries, may be related to the consumption of kanwa, in the postpartum period. The multiparity, African descent and pregnancy-induced hypertension are a few risk factors for PPCM. The exact etiology of PPCM is not known; possible theories range from myocarditis to the maladaptation to the changes of pregnancy. The clinical manifestation varies from shortness of breath to thromboembolic phenomenon. Echocardiography is essential for diagnosis as well as differential diagnosis of PPCM. These patients preferably are managed in tertiary healthcare facilities. Anticoagulation and antiarrhythmic medications are pillars for the management of PPCM patients. If required, mechanical devices should be used temporarily. PPCM patients may need heart transplant. The beneficial role of bromocriptine and immunosuppression is not clear in PPCM patients. Subsequent pregnancies should be avoided to prevent the PPCM occurrence.

Pregnancy, a unique case of heterochronic parabiosis and peripartum cardiomyopathy

“…Amniotic extracellular vesicles are produced by placental, fetal and amniotic cells, and are captured by cells of their target tissues via a process called "membrane ruffling" before fusing with target cells via receptor/ligand interaction [8]. While this process has evolved over more than 7,000,000 years for the human species, and in most pregnancies performs impeccably, few mothers experience pregnancy-related complications including a dreadful cardiac pathology described as peripartum cardiomyopathy (PPCM) [16,17].…”

“…PPCM is a dreadful condition with an incidence of 4470 new cases per year [16,17]. The definition of PPCM is "an idiopathic cardiomyopathy presenting with heart failure secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause of heart failure can be found."…”

“…The definition of PPCM is "an idiopathic cardiomyopathy presenting with heart failure secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause of heart failure can be found." (Heart Failure Association of the European Society of Cardiology Working Group on PPCM) [16]. Risk factors associated with PPCM include advanced maternal age, African-American race, chronic hypertension, preeclampsia, multiple gestations, and prolonged use of tocolytic drugs [16,17].…”

“…(Heart Failure Association of the European Society of Cardiology Working Group on PPCM) [16]. Risk factors associated with PPCM include advanced maternal age, African-American race, chronic hypertension, preeclampsia, multiple gestations, and prolonged use of tocolytic drugs [16,17]. There is no known etiology, however, in mice the 16K-PRL causes endothelium elevation of miR-146a, blocks angiogenesis, and leads to cardiomyopathy akin to PPCM via extracellular vesicles enriched in miR-146a [18][19][20].…”

“…We propose that the administration of amniotic extracellular vesicles, especially those produced at the end of normal pregnancies (last trimester), could be a safe and effective adjunct therapeutic strategy in combination with bromocriptine [30]. And this approach would be in addition, of course, to existing measures to support the failing left ventricle (left ventricular assist devices and other technologies), the control of arrhythmia (including with automatic implantable cardioverter-defibrillator AICD placement), and a drug regimen adapted from the management of severe heart failure [16].…”