Peripartum cardiomyopathy

Definition

• According to the ESC working group, peripartum cardiomyopathy is heart failure towards the end of pregnancy or postpartum without another identifiable cause, with left ventricular systolic dysfunction and an ejection fraction below 45%; the left ventricle may or may not be dilated.
• The classic 2000 definition required onset in the last month of pregnancy or within 5 months after birth without pre-existing structural heart disease; it is a diagnosis of exclusion.

Occurrence & epidemiology

Epidemiology

• Most women develop symptoms in the first month after birth; onset is possible from the third trimester up to 6 months postpartum.

Aetiopathogenesis

Aetiology and risk factors

• Increased oxidative stress is considered central: via cathepsin D it causes cleavage of prolactin into an anti-angiogenic, pro-apoptotic 16-kDa fragment; in addition, familial clustering and variants in cardiomyopathy genes such as TTN occur.

Clinical features

Clinical features and complications

• Typical are congestive features such as exertional dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, dry cough and pedal oedema, and non-specific complaints such as fatigue, palpitations and light-headedness, which resemble physiological changes of pregnancy.
• Thromboembolic complications, life-threatening arrhythmias, cardiogenic shock and sudden cardiac death may also occur.

Diagnosis

• The key investigations are ECG and echocardiography; a normal ECG does not exclude the condition.
• BNP and NT-proBNP correlate with outcome; cardiac MRI measures chamber volumes and ventricular function more precisely and is mostly used postpartum because of gadolinium.

Keep learning in the app

Further reading (selection)

1. StatPearls: Peripartum Cardiomyopathy (NCBI Bookshelf)
2. Heart Fail Rev 2021: Peripartum cardiomyopathy – a review (PMC, open access)

Cross-references