Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure (HF) that affects women late in pregnancy or in the early puerperium. There are several definitions for PPCM. While there are numerous potential mechanisms for Peripartum (post-partum) cardiomyopathy, its exact cause remains unknown1, but the etiopathogenesis is likely to be multifactorial. PPCM is uncommon before 36 weeks of pregnancy, and afflicted women generally present during the first month after delivery. PPCM should be differentiated from pre-existing cardiomyopathy, undiagnosed congenital heart disease, pre - existing valvular heart disease, myocardial infarction, pulmonary embolism and diastolic heart failure due to hypertensive heart disease. The principles for treating acute HF caused by PPCM are the same as those for acute HF caused by any other cause with some limitations during pregnancy. Prompt treatment is critical. There is no necessity for an early delivery unless the maternal or foetal health has deteriorated. In women who present with advanced HF with haemodynamic instability, urgent delivery, regardless of gestation, may be considered. Because women with PPCM have a significant chance of relapse in subsequent pregnancies, they need comprehensive contraceptive counselling. In general, the prognosis is good, with more than half of the patients regaining LV function spontaneously within six months of giving birth. Our aim is to put forth an in-depth review of the Peripartum Cardiomyopathy in contemporary practice.
Keywords : Peripartum cardiomyopathy · Heart failure · LV function · Cardiac MRI
Peripartum Cardiomyopathy (PPCM) is a rare cause of heart failure (HF) that affects women late in pregnancy or in the early puerperium. There are several definitions for PPCM, as follows:
• AHA Scientific Statement on contemporary definitions and classifications of the cardiomyopathies defines PPCM as a rare and dilated acquired primary cardiomyopathy with associated LV dysfunction and heart failure presenting in the third trimester of pregnancy or within five months post-partum, and whose diagnosis requires a high index of suspicion.
• European Society of Cardiology on the classification of cardiomyopathies defines PPCM as a non-familial, nongenetic form of dilated cardiomyopathy associated with the following characteristics:
(a) Development of heart failure (HF) toward the end of pregnancy or within five months following delivery.
(b) Absence of another identifiable cause for the HF.
(c) Left ventricular (LV) systolic dysfunction with an LV ejection fraction (LVEF) of <45%. The LV may or may not be dilated.
• Heart Failure Association of the European Society of Cardiology Working Group on PPCM 2010 defines PPCM as an idiopathic cardiomyopathy presenting with heart failure secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other apparent cause of heart failure is found. It is a diagnosis of exclusion. The left ventricle may not be dilated but the ejection fraction is nearly always reduced to below 45%.
Risk factors for the development of PPCM include maternal age over 30, African descent, multiparity, twin pregnancy, hypertension, preeclampsia, smoking, maternal cocaine abuse, extended tocolytic therapy and malnutrition.Pathophysiology
While there are numerous potential mechanisms for Peripartum (post-partum) Cardiomyopathy, its exact cause remains unknown [1], but the etiopathogenesis is likely to be multifactorial. The timing of presentation during late pregnancy and post-partum period is suggestive of potential hormonal pathogenesis.
Presentation of Peripartum Cardiomyopathy
Timing of Presentation PPCM is uncommon before 36 weeks of pregnancy, and afflicted women generally present during the first month after delivery.
