Peripartum cardiomyopathy (PPCM) is a form of dilated cardiomyopathy that presents in the third trimester of pregnancy or in the early post partum period.

As with other forms of dilated cardiomyopathy, postpartum cardiomyopathy involves deterioration of the left ventricular ejection fraction with associated congestive heart failure and increased risk of atrial and ventricular arrhythmias and even sudden cardiac death.

The etiology of postpartum cardiomyopathy is unknown.

Risk factors

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In the US he prevalence is estimated to be 1 case per 1300-15,000 live births.

The incidence of peripartum cardiomyopathy is increased in women over the age of 30, in twin pregnancies, in multiparous women, in women with gestational hypertension, those who have received tocolytic therapy, and in african americans.

Clinical Features (History)

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Pregnancy itself brings about some features that suggest cardiac insufficiency. Symptoms such as dyspnoea, dizziness, orthopnoea and decreased exercise tolerance are often normal findings in pregnancy.

The dyspnoea is described usually by the woman as the inability to take a deep breath in to get enough air into her lungs. It is thought that the hormonal (progesterone) mediated hyperventilation seen in pregnancy is the cause.

In PPCM the symptoms seen are the same as in patients with systolic dysfunction who are not pregnant. These symptoms include cough, orthopnoea, paroxysmal nocturnal dyspnoea, fatigue, palpitations, haemoptysis and chest pain.

Prognosis

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About 50 to 60 percent of women with postpartum cardiomyopathy have improvement or total recovery in their left ventricular function within 6 months of diagnosis. The remainder tend to have either stabilization of their ventricular function or worsening (requiring cardiac transplantation).¹

References

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1. Ravikishore AG, Kaul UA, Sethi KK, Khalilullah M. Peripartum cardiomyopathy: prognostic variables at initial evaluation. Int J Cardiol. 1991 Sep;32(3):377-80. (Medline abstract)

Cardiomyopathy | Obstetrics