Peripartum cardiomyopathy

This is a rare form of dilated cardiomyopathy that occurs within a month before, or 6 months after, delivery.

• should be suspected in any peripartum women presenting with symptoms and signs of heart failure, towards the end of pregnancy or in the months following delivery, with confirmed left ventricular dysfunction
• in general fulminating cases occur shortly after delivery, whilst milder cases occur later
• this condition is not generally associated with prematurity
• in severe disease treatment may require inotropes as well as diuretics
• on biopsy there is often myocarditis; the presence of inflammation has led to theories that the condition may result from breakdown in the usual immunological barrier between mother and her 'foreign' foetus

After good history taking, all women should be thoroughly assessed, and alternative causes should be excluded.

Urgent cardiac investigations with electrocardiogram and natriuretic peptide measurement (if available) should be performed

• echocardiography follows as the next step in investigation

Patients with abnormal cardiac investigations should be urgently referred to a cardiology team for expert management.

Referral for genetic work-up should be considered if there is a family history of cardiomyopathy or sudden death. PPCM is a disease with substantial maternal and neonatal morbidity and mortality.

Reference:

• Karen Sliwa, Johann Bauersachs, Zolt Arany, Timothy F Spracklen, Denise Hilfiker-Kleiner, Peripartum cardiomyopathy: from genetics to management, European Heart Journal, 2021;, ehab458.