Peripartum Cardiomyopathy

Peripartum cardiomyopathy, also called PPCM, is a form of dilated cardiomyopathy in which the heart’s normal strength is decreased to the point that it may be unable to fulfill the body’s vascular needs of a woman who is currently or has recently been pregnant. By definition, peripartum cardiomyopathy may appear from the first day of the last month of pregnancy to the last day of the 5 weeks period that comes after the actual delivery.

Causes Of Peripartum Cardiomyopathy

The physical cause of peripartum cardiomyopathy is unknown. The heart just becomes noticeably weaker without any physical signs of injury to the muscle itself. However, peripartum cardiomyopathy can be identified and differentiated from other diseases. All PPCM cases have some things in common: the lack of any demonstrable cause of cardiac failure, a documented systolic dysfunction, and absolute absence of any demonstrable heart disease prior to the last month of pregnancy.

Peripartum cardiomyopathy is more commonly found in women with multiple gestations, and also in women with preeclampsia, although there is no certainty about the relation between this last scenario and the development of an episode of peripartum cardiomyopathy. Some specialists think that PPCM is related to myocarditis, autoantibodies and low selenium levels on the body, but the studies are not conclusive.

Diagnosis And Treatment Of Peripartum Cardiomyopathy

As peripartum cardiomyopathy is, basically, a weakening of the heart that reduces its ability to pump blood, there are other organs which are affected, especially liver and lungs. This is evidenced by the PPCM common symptoms: orthopnea (apnea related to position), fatigue, swelling of the ankles and knees, nocturia (increase on the amount of urine produced at night) and chest palpitations. A woman suffering from PPCM also shows an enlarged heart.

Whenever this disease shows up, the patient should be hospitalized at least until the acute symptoms disappear. As peripartum cardiomyopathy is often reversible, any action that prioritizes a patient’s survival is highly recommended. And because pregnant women are usually young, a generally good evolution is expected.

For most women, treatment consists on relieving the symptoms. This therapy is the primary choice in common peripartum cardiomyopathy cases, and in some women the PPCM symptoms just disappear on their own. On severe cases, however, more extreme actions may be needed, like for instance the use of an aortic counter-pulsation balloon, therapy of immunosuppression or even a heart transplant.

Prognosis Of Peripartum Cardiomyopathy

As a general rule, women whose hearts return to normal size after five weeks of post-partum period are able to resume their normal lives with no or very little medication. On the other hand, if after this critical period there are no signs of heart improvement then a future pregnancy is very risky, as there are high chances of increasing the damage to the heart with another episode of peripartum cardiomyopathy.

Risk Factors Of Peripartum Cardiomyopathy

As all other heart diseases, peripartum cardiomyopathy is more severe on smoking women and women who consume alcohol. Chances of successful evolution of PPCM towards its cure are much greater on non-smoking, non-drinking women. Besides, a woman should never, ever consume tobacco, alcohol or any other harmful substance during pregnancy.

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