Peripartum Cardiomyopathy

Cardiac failure that develops during pregnancy or during the first 6 months postpartum in a woman without a history of heart disease and with no cause for heart failure other than pregnancy is termed peripartum cardiomyopathy. The incidence varies from 1:4000 to 1:1000. It is higher in Africa. It occurs more often in older women, those with twins, and in patients with pregnancy-induced hypertension. The cause of peripartum cardiomyopathy is unknown. In patients who continue to have symptoms and signs of disease for more than 6 months postpartum, the mortality rate is high, and subsequent pregnancy is especially dangerous.

 

Symptoms of peripartum cardiomyopathy are those of congestive heart failure. An ECG may reveal tachycardia and atrial or ventricular arrhythmias. Death may occur as a result of arrhythmia or embolism. Autopsy usually reveals an enlarged, dilated heart, and mural thrombi (the source of pulmonary and systemic emboli) are often found.

The treatment of peripartum cardiomyopathy is that of congestive cardiomyopathy. Patients with persistent cardiomegaly or mural thrombi shown by echocardiography require anticoagulant therapy. The long-term prognosis in these patients depends on whether cardiomegaly resolves within 6 months after the onset of symptoms. If it does not resolve, the 5-year mortality rate is 6%. If cardiomegaly does not resolve and another pregnancy intervenes, cardiomyopathy recurs in 50% of cases, with a 19% mortality rate.

Pearson GD et al: Peripartum cardiomyopathy: National Heart Lung and Blood Institute and Office of Rare Disease (National Institutes of Health) workshop recommendations and review. JAMA 2000;283:1183.