Peripartum Cardiomyopathy
Introduction
HeFSSA executive member, Dr Olaf Forster, is conducting research into peripartum cardiomyopathy at the Soweto Cardiovascular Research Unit.
Peripartum cardiomyopathy (PPCM) is defined as a disorder of unknown pathogenesis in which left ventricular dysfunction and symptoms of heart failure occur between the last month of pregnancy and the first five months postpartum in the absence of an identifiable cause of heart failure and in the absence of recognisable heart disease prior to the last month of pregnancy. Echocardiography demonstrates features of dilated cardiomyopathy with impaired ejection fraction, global dilatation and sometimes thinned-out walls. The symptoms and signs are similar to those in patients with idiopathic dilated cardiomyopathy.
The acute form of PPCM is a clinical syndrome with reduced cardiac output, tissue hypoperfusion, increase in the pulmonary capillary wedge pressure and tissue congestion. Monitoring of the patient with the acute form of PPCM should be initiated as soon as possible. The types and level of monitoring required for any individual patient vary widely depending on the severity of the cardiac decompensation and the response to initial therapy.
Treatment is directed toward symptomatic relief and improvement of cardiac function and similar to other forms of congestive heart failure. Current recommendations for treatment of the acute and the chronic form of PPCM are outlined. Maternal mortality differs between geographical regions and ranges between 9 and 15%. Prognosis of a subsequent pregnancy in known PPCM appears to be related to left ventricular dimensions at the onset of pregnancy. [Download PDF]
Sliwa K., Blauwet L, Tibazarwa K, Libhaber E, Smedema JP, Becker A, McMurray J, Yamac H, Labidi S, Struhman I and Hilfiker-Kleiner D Evaluation of Bromocriptine in the Treatment of Acute Severe Peripartum Cardiomyopathy. A Proof-of-Concept Pilot Study. Circulation 2010: 22 March.