Peripartum cardiomyopathy: Treatment and prognosis
- Wendy Tsang, MD
Wendy Tsang, MD
- Assistant Professor
- Toronto General Hospital
- University of Toronto
- Amy C Bales, MD
Amy C Bales, MD
- Assistant Professor of Clinical Medicine
- Midwestern University, Chicago College of Osteopathic Medicine
- Roberto M Lang, MD
Roberto M Lang, MD
- Professor of Medicine
- Pritzker School of Medicine of the University of Chicago
Peripartum cardiomyopathy (PPCM, also called pregnancy-associated cardiomyopathy) is a rare cause of heart failure (HF) that affects women late in pregnancy or in the early puerperium . Although initially described in 1849 , it was not recognized as a distinct clinical entity until the 1930s . Earlier terms for this condition include toxic postpartum HF, Meadows’ syndrome, Zaria syndrome, and postpartum myocardiosis.
Treatment of PPCM is similar to that employed for other types of HF with left ventricular systolic dysfunction. However, modifications to standard therapy are often necessary to ensure the safety of the mother and the unborn or breastfeeding child. (See "Management of heart failure during pregnancy", section on 'Management goals'.)
Etiology, clinical manifestations, and diagnosis of PPCM, critical illness during pregnancy and the peripartum period, HF during pregnancy, and issues related to pregnancy in women with acquired or congenital heart disease are discussed separately. (See "Peripartum cardiomyopathy: Etiology, clinical manifestations, and diagnosis" and "Critical illness during pregnancy and the peripartum period" and "Management of heart failure during pregnancy" and "Acquired heart disease and pregnancy" and "Pregnancy in women with congenital heart disease: General principles".)
Treatment of peripartum cardiomyopathy (PPCM) is largely similar to treatment for other types of heart failure (HF). Additional therapeutic issues include arrhythmia management. A pilot study suggested that bromocriptine may be helpful but further study is needed .
Heart failure treatment
Components of therapy — In women with PPCM and HF, the goals of medical therapy are similar to those in patients with acute and chronic systolic HF due to other causes. These include:
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- Heart failure treatment
- - Components of therapy
- Arrhythmia management
- Device therapy
- Antithrombotic therapy
- Mechanical circulatory support and cardiac transplantation
- Immunosuppressive agents
- Intravenous immune globulin
- THERAPY AFTER RECOVERY OF LEFT VENTRICULAR FUNCTION
- Maternal outcome
- - Mortality and morbidity
- - Recovery of left ventricular function
- Obstetric and neonatal outcomes
- Subsequent pregnancy
- - Recovered LV function
- - Persistent LV dysfunction
- SUMMARY AND RECOMMENDATIONS