PERIPARTUM CARDIOMYOPATHY: A CONDITION PHYSICIAN SHOULD BE AWARE OF!
Keywords:
Peripartum cardiomyopathy, PPCM, cardiomyopathy
Abstract
Peripartum cardiomyopathy (PPCM) is a poorly characterized, rare form of cardiomyopathy. The etiology of PPCM is unknown, but viral, autoimmune, and idiopathic causes may contribute (1). Risk factors include multiparity, age>30 years, multiple pregnancies, obesity, hypertension, and toxemia. The presentation is similar to other forms of congestive heart failure. Signs and symptoms of PPCM resemble systolic heart failure, and it is diagnosed by exclusion. The diagnosis of PPCM should not be considered until other causes of cardiac dysfunction are ruled out. Echocardiography is central to diagnosis. An echocardiogram typically reveals an ejection fraction of <45% and/or fractional shortening of <30%, along with a left ventricular end-diastolic dimension>2.7 cm/m2 of body surface area. (2) Treatment consists of diuretics, vasodilators, digoxin. Patients with PPCM are at high risk of thromboembolism, and therefore anticoagulation therapy should be considered.
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References
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8. Billieux M H, Petignat P, Fior A, et al. Pre-eclampsia and peripartum cardiomyopathy in molar pregnancy: clinical implication for maternally imprinted genes. Ultrasound Obstet Gynecol. Apr 2004;23(4):398-401.
9. Bultmann B D, Klingel K, Nabauer M et al: High prevalence of viral genomes and inflammation in peripartum cardiomyopathy. Am J Obstet Gynecol. Aug 2005;193:363-5.
10. K. M. Carlson, J. E. Browning, M. K. Eggleston, et al: “Peripartum cardiomyopathy presenting as lower extremity arterial thromboembolism. A case report,” Journal of Reproductive Medicine for the Obstetrician and Gynecologist, vol. 45, no. 4, pp. 351–353, 2000.
11. W. C. Cole, J. B. Mehta, T. M. Roy et al: “Peripartum cardiomyopathy: echocardiogram to predict prognosis,” Tennessee Medicine, vol. 94, no. 4, pp. 135–138, 2001. C. L. Hu, Y. B. Li, and Y. B. Li, “Troponin T measurement can predict persistent left ventricular dysfunction in peripartum cardiomyopathy,” Heart, vol. 93, no. 4, pp. 488–490, 2007. View at Publisher · View at Google Scholar · View at PubMedK
12. Iliwa, D. Skudicky, A. Bergemann, G et al: “Peripartum cardiomyopathy: analysis of clinical outcome, left ventricular function, plasma levels of cytokines and Fas/APO-1,” Journal of the American College of Cardiology, vol. 35, no. 3, pp. 701–705, 2000. View at Publisher · View at Google Scholar
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17. Regina Fragneto, MD University of Kentucky Department of Anesthesiology Peripartum Cardiomyopathy: A Current Review www.soap.org/media/newsletters/fall2003/pericardio
18. Nissar Shaikh Department of Anesthesia/ ICU and Pain Management, Hamad Medical Corporation, Doha, An obstetric emergency called peripartum cardiomyopathy. Qatar Jounal of Emergencies trauma and shock Year : 2010 Volume : 3 Issue : 1 Page : 39-42
19. Katie M. Twomley and Gretchen L. Wells J Peripartum Cardiomyopathy: A Current Review. Pregnancy. 2010; 2010: 149127.
20. Sliwa K, Fett J, Elkayam U. Natural course of peripartum cardiomyopathy Lancet. 2006 Aug19;368(9536):687-93
21. Demakis J G, Rahimtoola S H, Sutton GC, Meadows WR, Szanto PB, Tobin JR, Gunnar RM. Natural course of peripartum cardiomyopathy circulation. 1971 Dec;44(6):1053-61.
22. Sanderson JE, Olsen EG, Gatei D. Peripartum heart disease: an endomyocardial biopsy study Br Heart J. 1986 Sep;56(3):285-91.
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24. Radhakrishnan Ramraj: Peripartum cardiomyopathy: Causes, diagnosis, and treatment Cleveland Clinic Journal of Medicine, 76(5): 289-296.
25. Ray JG Vermeulen MJ, Koren Taking ACE inhibitors during early pregnancy: is it safe? Can Fam Physician 2007; 53:1439–1440.
26. Cooper WO, Hernandez-Diaz S, Arbogast PG, et al Major congenital malformations after first-trimester exposure to ACE inhibitors. N Engl J Med 2006; 354:2443–2451.
27. Pearson GD, Veille JC, Rahimtoola S, et al Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review. JAMA 2000; 283:1183–1188
28. Clark NP, Delate T, Witt DM, Parker S, McDuffie R A descriptive evaluation of unfractionated heparin use during pregnancy. J Thromb Thrombolysis 2008 epub March 8.
29. Jessup M, Brozena S Heart failure. N Engl J Med 2003; 348:2007–2018.
30. Sliwa K, Skudicky D, Candy G, Bergemann A, et al: The addition of pentoxifylline to conventional therapy improves outcomes in patients with peripartum cardiomyopathy. Eur J Heart Fail 2002; 4:305–309.
31. Kishimoto C, Shioji K, Kinoshita M, et al Treatment of acute inflammatory cardiomyopathy with intravenous immunoglobulin ameliorates left ventricular function associated with suppression of inflammatory cytokines and decreased oxidative stress. Int J Cardiol 2003; 91:173–178.
32. Fett JD Inflammation and virus in dilated cardiomyopathy as indicated by endomyocardial biopsy. Int J Cardiol 2006; 112:125–126.
33. Ifiker-Kleiner D, Meyer GP, Schieffer E, et al Recovery from postpartum cardiomyopathy in 2 patients by blocking prolactin release with bromocriptine. J Am Coll Cardiol 2007; 50:2354–2355.
34. Fett JD, Sannon H, Thelisma E et al:. Recovery from severe heart failure following peripartum cardiomyopathy. Int J Gynaecol Obstet 2009; 104(2): 125–7.
35. Elkayam U, Akhter MW, Singh H et al: A. Pregnancy-associated cardiomyopathy: clinical characteristics and a comparison between early and late presentation. Circulation 2005; 111(16):2050–5.
36. Amos AM, Jaber WA, Russell SD. Improved outcomes in peripartum cardiomyopathy with contemporary. Am Heart J 2006;152(3):509–13.
37. Sliwa K, Forster O, Libhaber E, et al: Peripartum cardiomyopathy: inflammatory markers as predictors of outcome in 100 prospectively studied patients. Eur Heart J 2006;27 (4):441–6.
38. Anirban Bhattacharyya, MD, Sukhdeep Singh Basra, MD, MPH, Priyanka Sen, et al: Peripartum Cardiomyopathy A Review, Tex Heart Inst J v.39(1); 2012.
39. Elkayam U, Tummala PP, Rao K et al. Maternal and fetal outcomes of subsequent pregnancies in women with peripartum cardiomyopathy [published erratum appears in N Engl J Med 2001;345(7): 552]. N Engl J Med 2001;344(21):1567–71.
40. Fett J D, Fristoe K L, Welsh S N. Risk of heart failure relapse in subsequent pregnancy among peripartum cardiomyopathy mothers. Int J Gynaecol Obstet 2010;109(1):34–6.
41. Mandal D, Mandal S, Mukherjee D et al. Pregnancy and subsequent pregnancy outcomes in peripartum cardiomyopathy. J Obstet Gynaecol Res 2011; 37(3):222–7.
42. Fett J D, Fristoe K L, Welsh S N. Risk of heart failure relapse in subsequent pregnancy among peripartum cardiomyopathy mothers. Int J Gynaecol Obstet 2010; 109(1):34–6.
43. Sliwa K, Hilfiker-Kleiner D, Petrie MC et al. Current state of knowledge on etiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail 2010; 12(8): 767–78.
2. Satpathy HK, Frey D, Satpathy R et al: Peripartum cardiomyopathy, Postgrad Med. 2008 Apr;120(1):28-32.
3. Heider A L, Kuller J A, Strauss R A, et al: Peripartum cardiomyopathy: a review of the literature. Obstet Gynecol Surv.1999 Aug;54(8):526-31. Review.
4. Lee W. Clinical management of gravid women with peripartum cardiomyopathy Obstet Gynecol Clin North Am. 1991 Jun;18(2):257-71. Review
5. Ladwig P, Fischer E Aust N Z J: Peripartum cardiomyopathy Obstet Gynaecol. 1997 May;37(2):156-60.
6. Michael P Carson, M D; Chief Editor: Henry H Ooi, M B, MRCP Peripartum cardiomyopathy Medscape reference
7. Ansari A A, Fett J D, Carraway R E, et al. Autoimmune mechanisms as the basis for human peripartum cardiomyopathy. Clin Rev Allergy Immunol. Dec 2002;23(3):301-24.
8. Billieux M H, Petignat P, Fior A, et al. Pre-eclampsia and peripartum cardiomyopathy in molar pregnancy: clinical implication for maternally imprinted genes. Ultrasound Obstet Gynecol. Apr 2004;23(4):398-401.
9. Bultmann B D, Klingel K, Nabauer M et al: High prevalence of viral genomes and inflammation in peripartum cardiomyopathy. Am J Obstet Gynecol. Aug 2005;193:363-5.
10. K. M. Carlson, J. E. Browning, M. K. Eggleston, et al: “Peripartum cardiomyopathy presenting as lower extremity arterial thromboembolism. A case report,” Journal of Reproductive Medicine for the Obstetrician and Gynecologist, vol. 45, no. 4, pp. 351–353, 2000.
11. W. C. Cole, J. B. Mehta, T. M. Roy et al: “Peripartum cardiomyopathy: echocardiogram to predict prognosis,” Tennessee Medicine, vol. 94, no. 4, pp. 135–138, 2001. C. L. Hu, Y. B. Li, and Y. B. Li, “Troponin T measurement can predict persistent left ventricular dysfunction in peripartum cardiomyopathy,” Heart, vol. 93, no. 4, pp. 488–490, 2007. View at Publisher · View at Google Scholar · View at PubMedK
12. Iliwa, D. Skudicky, A. Bergemann, G et al: “Peripartum cardiomyopathy: analysis of clinical outcome, left ventricular function, plasma levels of cytokines and Fas/APO-1,” Journal of the American College of Cardiology, vol. 35, no. 3, pp. 701–705, 2000. View at Publisher · View at Google Scholar
13. A. A. Ansari, J. D. Fett, R. E. Carraway: “Autoimmune mechanisms as the basis for human peripartum cardiomyopathy,” Clinical Reviews in Allergy and Immunology, vol. 23, no. 3, pp. 301–324, 2002. View at Publisher · View at Google Scholar · View at PubMed
14. O. Adesanya, F. I. Anjorin, I. O. Adeoshun: “Peripartum cardiac failure. A ten-year follow-up study,” Tropical and Geographical Medicine, vol. 41, no. 3, pp. 190–196, 1989.
15. D.Hilfiker-Kleiner, G. P. Meyer, and G. P. Meyer, “Recovery from postpartum cardiomyopathy in 2 patients by blocking prolactin release with bromocriptine,” Journal of the American College of Cardiology, vol. 50, no. 24, pp. 2354–2355, 2007.
16. A. M. Amos, W. A. Jaber, and S. D. Russell, “Improved outcomes in peripartum cardiomyopathy with contemporary,” American Heart Journal, vol. 152, no. 3, pp. 509–513, 2006.
17. Regina Fragneto, MD University of Kentucky Department of Anesthesiology Peripartum Cardiomyopathy: A Current Review www.soap.org/media/newsletters/fall2003/pericardio
18. Nissar Shaikh Department of Anesthesia/ ICU and Pain Management, Hamad Medical Corporation, Doha, An obstetric emergency called peripartum cardiomyopathy. Qatar Jounal of Emergencies trauma and shock Year : 2010 Volume : 3 Issue : 1 Page : 39-42
19. Katie M. Twomley and Gretchen L. Wells J Peripartum Cardiomyopathy: A Current Review. Pregnancy. 2010; 2010: 149127.
20. Sliwa K, Fett J, Elkayam U. Natural course of peripartum cardiomyopathy Lancet. 2006 Aug19;368(9536):687-93
21. Demakis J G, Rahimtoola S H, Sutton GC, Meadows WR, Szanto PB, Tobin JR, Gunnar RM. Natural course of peripartum cardiomyopathy circulation. 1971 Dec;44(6):1053-61.
22. Sanderson JE, Olsen EG, Gatei D. Peripartum heart disease: an endomyocardial biopsy study Br Heart J. 1986 Sep;56(3):285-91.
23. Denise Hilfiker-Kleiner, Prof. Dr. rer. nat.,1 Elisabeth Schieffer, Dr. med.,1 Gerd Peter Meyer, PD Dr. med.,1 Edith Podewski, Dr. med.,1 and Helmut Drexler, Prof. Dr. Postpartum Cardiomyopathy A Cardiac Emergency for Gynecologists, General Practitioners, Internists, Pulmonologists, and Cardiologis med Dtsch Arztebl Int. 2008 October; 105(44): 751–756.
24. Radhakrishnan Ramraj: Peripartum cardiomyopathy: Causes, diagnosis, and treatment Cleveland Clinic Journal of Medicine, 76(5): 289-296.
25. Ray JG Vermeulen MJ, Koren Taking ACE inhibitors during early pregnancy: is it safe? Can Fam Physician 2007; 53:1439–1440.
26. Cooper WO, Hernandez-Diaz S, Arbogast PG, et al Major congenital malformations after first-trimester exposure to ACE inhibitors. N Engl J Med 2006; 354:2443–2451.
27. Pearson GD, Veille JC, Rahimtoola S, et al Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review. JAMA 2000; 283:1183–1188
28. Clark NP, Delate T, Witt DM, Parker S, McDuffie R A descriptive evaluation of unfractionated heparin use during pregnancy. J Thromb Thrombolysis 2008 epub March 8.
29. Jessup M, Brozena S Heart failure. N Engl J Med 2003; 348:2007–2018.
30. Sliwa K, Skudicky D, Candy G, Bergemann A, et al: The addition of pentoxifylline to conventional therapy improves outcomes in patients with peripartum cardiomyopathy. Eur J Heart Fail 2002; 4:305–309.
31. Kishimoto C, Shioji K, Kinoshita M, et al Treatment of acute inflammatory cardiomyopathy with intravenous immunoglobulin ameliorates left ventricular function associated with suppression of inflammatory cytokines and decreased oxidative stress. Int J Cardiol 2003; 91:173–178.
32. Fett JD Inflammation and virus in dilated cardiomyopathy as indicated by endomyocardial biopsy. Int J Cardiol 2006; 112:125–126.
33. Ifiker-Kleiner D, Meyer GP, Schieffer E, et al Recovery from postpartum cardiomyopathy in 2 patients by blocking prolactin release with bromocriptine. J Am Coll Cardiol 2007; 50:2354–2355.
34. Fett JD, Sannon H, Thelisma E et al:. Recovery from severe heart failure following peripartum cardiomyopathy. Int J Gynaecol Obstet 2009; 104(2): 125–7.
35. Elkayam U, Akhter MW, Singh H et al: A. Pregnancy-associated cardiomyopathy: clinical characteristics and a comparison between early and late presentation. Circulation 2005; 111(16):2050–5.
36. Amos AM, Jaber WA, Russell SD. Improved outcomes in peripartum cardiomyopathy with contemporary. Am Heart J 2006;152(3):509–13.
37. Sliwa K, Forster O, Libhaber E, et al: Peripartum cardiomyopathy: inflammatory markers as predictors of outcome in 100 prospectively studied patients. Eur Heart J 2006;27 (4):441–6.
38. Anirban Bhattacharyya, MD, Sukhdeep Singh Basra, MD, MPH, Priyanka Sen, et al: Peripartum Cardiomyopathy A Review, Tex Heart Inst J v.39(1); 2012.
39. Elkayam U, Tummala PP, Rao K et al. Maternal and fetal outcomes of subsequent pregnancies in women with peripartum cardiomyopathy [published erratum appears in N Engl J Med 2001;345(7): 552]. N Engl J Med 2001;344(21):1567–71.
40. Fett J D, Fristoe K L, Welsh S N. Risk of heart failure relapse in subsequent pregnancy among peripartum cardiomyopathy mothers. Int J Gynaecol Obstet 2010;109(1):34–6.
41. Mandal D, Mandal S, Mukherjee D et al. Pregnancy and subsequent pregnancy outcomes in peripartum cardiomyopathy. J Obstet Gynaecol Res 2011; 37(3):222–7.
42. Fett J D, Fristoe K L, Welsh S N. Risk of heart failure relapse in subsequent pregnancy among peripartum cardiomyopathy mothers. Int J Gynaecol Obstet 2010; 109(1):34–6.
43. Sliwa K, Hilfiker-Kleiner D, Petrie MC et al. Current state of knowledge on etiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail 2010; 12(8): 767–78.
How to Cite
1.
Ingle V. PERIPARTUM CARDIOMYOPATHY: A CONDITION PHYSICIAN SHOULD BE AWARE OF!. Med. res. chronicles [Internet]. 2015Apr.20 [cited 2024Nov.22];2(2):243-50. Available from: https://medrech.com/index.php/medrech/article/view/78
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Review Article
