Cardiomyopathy - peripartum

Definition

Peripartum cardiomyopathy is a rare disorder in which a weakened heart is diagnosed within the final month of pregnancy or within 5 months after delivery.

Cardiomyopathy occurs when there is damage to the heart. As a result, the heart muscle becomes weak and cannot pump blood efficiently. Decreased heart function affects the lungs, liver, and other body systems.

Alternative Names

Causes

Peripartum cardiomyopathy is a form of dilated cardiomyopathy in which no other cause of heart dysfunction (weakened heart) can be identified.

In the United States, peripartum cardiomyopathy complicates 1 in every 1,300 - 4,000 deliveries. It may occur in childbearing women of any age, but it is most common after age 30.

Risk factors include obesity, having a personal history of cardiac disorders such as myocarditis, use of certain medications, smoking, alcoholism, multiple pregnancies, being African-American, and being malnourished.

Symptoms

• Shortness of breath
  • On exertion
  • When lying flat (orthopnea)
• Fatigue
• Swelling of the ankles
• Increased night-time urination (nocturia)
• Feeling of racing heart or skipping beats (palpitations)

Exams and Tests

During a physical examination, the physician will look for signs of fluid in the lungs by touching and tapping with the fingers. Listening to the chest with a stethoscope will reveal lung crackles, a rapid heart rate, or abnormal heart sounds.

The liver may be enlarged and neck veins may be swollen. Blood pressure may be low or may drop when the patient stands up.

Heart enlargement, congestion of the lungs or the veins in the lungs, decreased cardiac output, decreased movement or functioning of the heart, or heart failure may show on:

• Echocardiogram
• Chest x-ray
• Chest CT scan
• Coronary angiography
• Nuclear heart scan (MUGA, RNV)

An ECG can show enlargement of the heart; problems with the electrical part of the heart, called conduction disturbances; and arrhythmias, such as atrial fibrillation, ventricular tachycardia, or an ectopic heartbeat (premature or abnormal beat). A heart biopsy may be helpful in determining an underlying cause of cardiomyopathy

Many cases of peripartum cardiomyopathy seem to be related to myocarditis, which can be confirmed by a heart biopsy.

Treatment

Hospitalization may be required until acute symptoms subside. Because heart dysfunction is usually reversible, and the patients are usually young, everything possible will be done to ensure survival.

This may include taking extreme measures such as using an aortic counterpulsation balloon (balloon pump), immunosuppressive therapy (such as that used to treat cancer or prevent rejection of a transplanted organ), or a heart transplant.

For most women, however, treatment focuses simply on relieving the symptoms. Some symptoms resolve on their own without treatment.

Medications include diuretics (water pills) to remove excess fluid, digitalis to strengthen the heart's pumping ability, and low-dose beta-blockers. A low-salt diet may be recommended. Fluid may be restricted in some cases. Activities, including nursing the baby, may be limited when symptoms develop.

Daily weighing may be recommended. A weight gain of 3 or 4 pounds or more over 1 or 2 days may indicate fluid accumulation.

Smoking and drinking alcohol must be stopped, as these habits may make the symptoms worse.

Outlook (Prognosis)

There are several possible outcomes in peripartum cardiomyopathy. Some women remain stable for long periods, while others deteriorate gradually. Some deteriorate rapidly and may be candidates for a heart transplant. The death rate may be as high as 25 - 50%.

For women whose hearts returns to normal size after the baby is born, the prognosis is good. If the heart remains enlarged, future pregnancies may result in heart failure. It is not known how to predict who will recover and who will develop severe heart failure.

Women who develop peripartum cardiomyopathy are at high risk of developing the same problem with future progenancies and should discuss contraception with their physician.

Possible Complications

• Congestive heart failure
• Cardiac arrhythmias, some of which may be deadly
• Pulmonary emboli (blood clots in the lungs)

When to Contact a Medical Professional

• If you are currently pregnant or recently delivered a baby and think you may have signs that cardiomyopathy may be developing
• You develop chest pain, palpitations, faintness, or other new or unexplained symptoms

Prevention

Eat a well-balanced, nutritious diet; exercise to increase cardiovascular fitness; and avoid cigarettes and alcohol. You should also avoid getting pregnant again if you experienced heart failure during a previous pregnancy.