Peripartum cardiomyopathy (PPCM) is a rare cause of dilated cardiomyopathy that occurs in approximately 1 in 2,500 to 4,000 live births. It is often difficult to diagnose as the symptoms of HF mimic those of pregnancy (e.g., fatigue, shortness of breath (SOB), swollen ankles, weight gain).
PPCM is diagnosed when the following 3 criteria are met:
- HF develops in the last month of pregnancy or within 5 months of delivery
- Heart pumping function is reduced, with an ejection fraction (EF) less than 45%
- No other cause for HF with reduced EF can be found
The specific cause of PPCM is unknown, however, it is thought to perhaps relate to a viral illness or abnormal immune response.
Other potential causes of PPCM include:
- Genetic mutation
- Coronary artery spasm
- Small vessel disease
- Nutritional deficiencies
- Defective antioxidant defences
Older maternal age, multiparity, multifoetal pregnancies (e.g., twins), high blood pressure and African descent appear to incur a higher risk.
Outcomes for patients with PPCM have improved in recent years, with survival rates as high as 90% to 95% with appropriate therapy. [#givertz-m.-2013] Although early improvement in EF (i.e., within the first 3-6 months) predicts a good outcome, some women will have slow, gradual improvement in EF over a number of years.
These patients as well as those with cardiomyopathy from other causes who become pregnant, require specific advice relating to:
The Pregnancy and cardiomyopathy booklet is a useful resource that addresses these issues for the patient.