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A contemporary review of peripartum cardiomyopathy

02 June 2015
11 min read
Volume 23 · Issue 6

Abstract

Heart disease is the single leading cause of maternal death in the UK and peripartum cardiomyopathy (PPCM), although rare, is frequently found within the cardiac maternal mortality statistics. It is too often diagnosed late, and frequently results in death, a trend that could be reversed with greater recognition of the problem. The hallmark of PPCM is the development of impaired ventricular function with depressed ejection fraction during pregnancy or for up to 6 months postpartum. The aetiology remains unknown but its presentation and treatment are similar to heart failure due to any other cause.

This article discusses the background, clinical presentation, diagnosis, outcome, prognosis and treatment available for women diagnosed with PPCM. Its aim is to raise awareness of the condition and provide the knowledge-base, which will help the reader make an earlier diagnosis and potentially save lives.

Peripartum cardiomyopathy (PPCM) is defined as the development of an idiopathic cardiomyopathy presenting with heart failure secondary to left ventricular systolic dysfunction, towards the end of pregnancy or in the months following birth, where no other cause of heart failure is found. All other possible causes of heart failure, for example coronary heart disease, myocarditis, must be excluded before the diagnosis can be made. The left ventricle is not always dilated but the ejection fraction is always reduced below 45% (Sliwa et al, 2010).

PPCM is difficult to diagnose because breathlessness, reduced exercise tolerance and feeling short of breath lying flat are not uncommon in normal pregnancy. The diagnosis of PPCM therefore relies on awareness of the condition by medical professionals, who must appreciate that progressive symptoms are abnormal and investigate appropriately. If PPCM is suspected this should prompt immediate referral to a cardiologist with urgent chest X-ray and echocardiography.

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