Peripartum Cardiomyopathy

Peripartum Cardiomyopathy and Takotsubo Cardiomyopathy: Rare Contributors to Cardiac Causes of Maternal Mortality

Peripartum cardiomyopathy (PPCM) and takotsubo cardiomyopathy (TCM) are cardiac conditions that can occur in the peripartum period. They have distinct characteristics and incidence rates; although rare, both contribute to the second leading cause of all-cause maternal mortality in the state of Missouri. PPCM can lead to heart failure, and TCM can cause acute arrhythmias leading to sudden cardiac death in otherwise healthy individuals. Our patient developed PPCM and TCM, which led to myocardial infarction, resulting in anoxic brain injury at 10 months postpartum. This case presentation demonstrates the need to consider pregnancy-related conditions up to 12 months postpartum. We postulate that the cardiomyopathies could have presented as early as five to eight weeks postpartum. Had our patient received screening for cardiac disease, resulting in earlier diagnosis and treatment, she may still be alive today. Increased surveillance and suspicion of cardiac diseases are crucial to reducing early and late postpartum mortality. Our patient presented to the ER for a headache three days before developing cardiac arrest. Our recommendation would be to screen any asymptomatic woman up to 12 months postpartum with an electrocardiogram and brain natriuretic peptide and compare the results to the baseline, if available. If any results from the screening tests are abnormal, clinicians should further investigate with troponin levels and echocardiography. We recommended reporting this case to the Missouri Maternal Mortality Review Committee and a hospital autopsy be performed for further investigation and contribute to our understanding of high maternal deaths in the state.

Peripartum cardiomyopathy unveiled: Etiology, diagnosis, and therapeutic insights

Peripartum cardiomyopathy (PPCM) remains a significant challenge in maternal health, marked by its unpredictable onset and varied clinical outcomes. With rising incidence rates globally, understanding PPCM is vital for improving maternal care and prognosis. This review aims to consolidate current knowledge on PPCM, highlighting recent advancements in its diagnosis, management, and therapeutic approaches. This comprehensive review delves into the epidemiology of PPCM, underscoring its global impact and demographic variations. We explore the complex etiology of the condition, examining known risk factors and discussing the potential pathophysiological mechanisms, including oxidative stress and hormonal influences. The clinical presentation of PPCM, often similar yet distinct from other forms of cardiomyopathy, is analyzed to aid in differential diagnosis. Diagnostic challenges are addressed, emphasizing the role of advanced imaging and biomarkers. Current management strategies are reviewed, focusing on the absence of disease-specific treatments and the application of general heart failure protocols. The review also discusses the prognosis of PPCM, factors influencing recovery, and the implications for future pregnancies. Finally, we highlight emerging research directions and the urgent need for disease-specific therapies, aiming to provide a roadmap for future studies and improved patient care. This review serves as a crucial resource for clinicians and researchers, contributing to a deeper understanding and better management of PPCM.

Peripartum cardiomyopathy: A review

Peripartum cardiomyopathy is a rare type of heart failure manifesting towards the end of pregnancy or in the months following delivery, in the absence of any other cause of heart failure. There is a wide range of incidence across countries reflecting different population demographics, uncertainty over definitions and under-reporting. Race, ethnicity, multiparity and advanced maternal age are considered important risk factors for the disease. Its etiopathogenesis is incompletely understood and is likely multifactorial, including hemodynamic stresses of pregnancy, vasculo-hormonal factors, inflammation, immunology and genetics. Affected women present with heart failure secondary to reduced left ventricular systolic function (LVEF <45%) and often with associated phenotypes such as LV dilatation, biatrial dilatation, reduced systolic function, impaired diastolic function, and increased pulmonary pressure. Electrocardiography, echocardiography, magnetic resonance imaging, endomyocardial biopsy, and certain blood biomarkers aid in diagnosis and management. Treatment for peripartum cardiomyopathy depends on the stage of pregnancy or postpartum, disease severity and whether the woman is breastfeeding. It includes standard pharmacological therapies for heart failure, within the safety restrictions for pregnancy and lactation. Targeted therapies such as bromocriptine have shown promise in early, small studies, with large definitive trials currently underway. Failure of medical interventions may require mechanical support and transplantation in severe cases. Peripartum cardiomyopathy carries a high mortality rate of up to 10% and a high risk of relapse in subsequent pregnancies, but over half of women present normalization of LV function within a year of diagnosis.

Peripartum cardiomyopathy in an elderly woman: A case report

Cardiomyopathy accounts for 11.5% cause of pregnancy-related deaths. The causes of peripartum cardiomyopathy (PPCM) are unknown, including predisposing factors such as abnormal response to the greater hemodynamic burden of pregnancy, viral myocarditis, malnutrition, inflammation, and apoptosis. Elderly women, twin gestation, preeclampsia, smoking, and anemia are potential high-risk factors for PPCM. Here, rare case of a patient is described that presented with complaints of breathlessness, cough, and symptoms of heart failure and was diagnosed early as PPCM based on 2D echocardiography and was managed with medical therapy and timely delivery of fetus. Symptomatic relief of symptoms was relieved by diuretics, inotropic drugs, and beta-blockers. The left ventricular ejection fraction increased eventually over 3 weeks and now the patient is a follow-up case since two years from the time of episode. In conclusion, PPCM is rare, which requires prompt management and heightened mindfulness; therefore, early detection and timely treatment can reduce maternal mortality.

Peripartum Cardiomyopathy: Current Understanding of Pathophysiology, Diagnostic Workup, Management, and Outcomes

Peripartum cardiomyopathy (PPCM) is a relatively rare, potentially life-threatening, idiopathic form of cardiomyopathy that affects previously healthy young women during late pregnancy or in the early postpartum period and is characterized by left ventricular systolic dysfunction in the absence of any other identifiable cardiac causes. Morbidity and mortality with PPCM are remarkably high and it continues to be one of the leading causes of maternal death. Although remarkable advances have been made in our understanding of PPCM in the last few decades, unanswered questions remain regarding its pathophysiology, diagnostic workup, and management options. In this article, we will complete an updated, comprehensive review of PPCM, including the epidemiology and risk factors, proposed etiology, presentation and complications, management, prognostic indicators and outcomes. In addition, we will identify current challenges and gaps in knowledge.

Meta-Analysis of Long-Term (>1 Year) Cardiac Outcomes of Peripartum Cardiomyopathy

Peripartum cardiomyopathy is the development of heart failure toward the end of pregnancy or in the months after delivery in the absence of other attributable causes, with left ventricular systolic dysfunction and a left ventricular ejection fraction (LVEF) generally <45%. Given that patients are relatively young at the time of diagnosis, this study was performed to summarize current evidence surrounding the long-term cardiac outcomes. MEDLINE, Embase, Cochrane CENTRAL, and CINAHL were searched for original studies that reported long-term (>1 year) patient outcomes. Of the 3,144 total records identified, 62 studies involving 4,282 patients met the selection criteria. The mean LVEF was 28% at diagnosis and 47% at the time of the last follow-up. Approximately half of the patients achieved myocardial recovery (47%), most commonly defined as an LVEF >50% (n = 21). The prevalence of implantable cardioverter-defibrillator use, left ventricular assist device implantation, and heart transplantation was 12%, 7%, and 11%, respectively. The overall all-cause mortality was 9%, and despite having more cardiovascular risk factors, patients residing in high-income countries had superior outcomes, including reduced rates of mortality.