Practical management of peripartum cardiomyopathy

Abstract

Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy that causes systolic heart failure (HF) in previously healthy young women. Despite latest remarkable achievement, unifying pathophysiologic mechanism is not well established. Considering close temporal relationship to pregnancy, the recent prolactin theory is promising. Abnormal short form of 16-kDa prolactin may be produced in the oxidative stress milieu, show anti-angiogenic effect and damage cardiovascular structure in late pregnancy. Future study is needed to determine whether abnormal prolactin system is useful as a biomarker for diagnosis and therapy of PPCM. Diagnosis is made based on the finding of left ventricular systolic dysfunction after excluding other causes of HF. A multidisciplinary team approach is essential for acute HF, antepartum, labor and postpartum care. Recovery from left ventricular dysfunction is critical for prognosis. As PPCM can recur and cause serious clinical events, subsequent pregnancy is not recommended. This review focuses on the practical management of PPCM.

Arrhythmic manifestation of peripartum cardiomyopathy—Case report

“…In case of subsequent pregnancy optimal pharmacotherapy should be implemented and therapeutic decisions should be made in interdisciplinary team of cardiologists, obstetricians, anesthetists, and neonatologists (Hilfiker-Kleiner et al, 2015;Świątecka, 2006). Since left ventricular systolic function often tends to deteriorate in the third trimester, regular echocardiographic monitoring during this period (e.g., every 2 weeks) seems to be helpful (Kim and Shin, 2017).…”

“…Since left ventricular systolic function often tends to deteriorate in the third trimester, regular echocardiographic monitoring during this period (e.g., every 2 weeks) seems to be helpful (Kim and Shin, 2017). Since left ventricular systolic function often tends to deteriorate in the third trimester, regular echocardiographic monitoring during this period (e.g., every 2 weeks) seems to be helpful (Kim and Shin, 2017).…”

Anesthetic Management and Perioperative Events of Peripartum Cardiomyopathy during Cesarean Delivery a Series of Five Cases

“…Echo findings consistent with PPCM include a decreased ejection fraction, global dilatation, and thinned-out cardiac walls. 10 Brain natriuretic peptide (BNP) or N-terminal pro-brain natriuretic peptide (NTproBNP) levels have high sensitivity in HF. NTproBNP levels of 100 pg/mL or less have a high negative predictive value for adverse maternal events and can be helpful to screen potential PPCM.…”

“…NTproBNP levels of 100 pg/mL or less have a high negative predictive value for adverse maternal events and can be helpful to screen potential PPCM. 10 Cardiac magnetic resonance imaging can be a complementary tool in the diagnosis and further evaluation of PPCM women. 11 In this case series, four out of the five patients presented with dyspnea after 36 weeks of gestation.…”

Kardiomiopatia połogowa — wciąż niepoznana. Aktualny stan wiedzy

“…Rozpoznanie PPCM jest ustalane na podstawie wykluczenia innych przyczyn HF [15]. Chorobę należy podejrzewać u wszystkich kobiet w okresie okołoporodowym z objawami HF lub u których następuje opóźnienie w powrocie do stanu zdrowia sprzed ciąży [16]. 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).…”