Cardiac disease in pregnancy and peripartum cardiomyopathy

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Special Scenarios: I. Pre-existing Cardiac Disease: Congenital Heart Disease Repaired Congenital Heart Disease Pulmonary Hypertension Rheumatic Heart Disease Connective Tissue Disorders II. Valvular Heart Disease: Mitral Stenosis Mitral Regurgitation Aortic Insufficiency Aortic Stenosis Mechanical Prosthetic Valves Tissue Prosthetic Valves III. Cardiomyopathy: Dilated Cardiomyopathy Hypertrophic Cardiomyopathy Peripartum Cardiomyopathy IV. Cardiac diseases that may develop During Pregnancy: Arrhythmias Acute Myocardial Infarction Hypertension
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Peripartum cardiomyopathy is defined as:

• Heart failure within last month of pregnancy or five months postpartum
• Absence of prior heart disease
• No determinable cause
• Strict echocardiographic indication of left ventricular dysfunction:

• Ejection fraction <45% and/or
• Fractional shortening <30%
• End-diastolic dimension >2.7 cm/m2 BSA (body surface area)

Common Mimickers

• Accelerated HTN
• Infection/sepsis
• Diastolic dysfunction
• High output state of pregnancy

Demographics

• Estimates of incidence 1/1300-15000
• Previous studies likely overestimated
• More common in women with:

• Multiple pregnancies
• African decent
• h/o toxemia
• Long-term tocolytic use
• Age>30
• Twin Pregnancy

• Etiology remains unknown
• Signs and sxs similar to those of nl pregnancy

Hemodynamic Findings

Chamber	Normal Pregnancy	Peripartum cardiomyopathy
RA	2	11 (2-34)
PA	11	39 (18-62)
PCW	6	18 (5-32)
CO (L/min)	7	6 (5-9)
HR	83	104 (76-142)

Treatment of Peripartum Cardiomyopathy

• Digoxin and diuretics are Class C
• ACE inhibitors absolutely contraindicated prepartum (hydralazine drug of choice)
• Anticoagulation recommended (Heparin prepartum and coumadin postpartum)

Outcome of Peripartum Cardiomyopathy

• Mortality 25-50% (half deaths in first 3 months)
• Remainder stable/recover within 6 months
• Can recur with subsequent pregnancies
• Favorable outcomes with cardiac transplantation

References

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