Peripartum cardiomyopathy

1. DR.JABIN V

3.  Two major devisions
1. Primary cardiomyopathies-predominantly
confined to heart muscle
 eg:hypertrophic cardiomyopathy
 dilated cardiomyopathy
 Peripartum cardiomyopathy
2.Secondary cardiomyopathies-result from
generalised systemic disorders that
produce pathological myocardial
involvement
Eg:DM,SLE,CHRONIC HTN,thyroid disorders

4.  THE DISORDER IS SIMILAR TO OTHER FORMS OF
NONISCHEMIC DILATED CARDIOMYOPATHIES
EXCEPT FOR ITS UNIQUE RELATIONSHIP WITH
PREGNANCY
 Currently it is a diagnosis of exclusion

5. 1. Development of heart failure in the last
month of pregnancy or within 5 months
after delivery
2. Absance of an identifiable cause for heart
failure
3. Absance of recognizable heart disease
prior to last month of pregnancy
4. LV systolic dysfunction demonstated by
classic echocardiographic criteria,such as
depressed ejection fraction or fractional
shortening along with a dilated LV

7.  Advanced maternal age
 Multi parity
 Multiple gestation
 Obesity
 Black race

8.  Remains unknown
 Proposed causes include
1. Viral myocarditis-Parvo virus B19,HHV
6,EBV,CMV
2. Abnormal immune response to pregnancy
3. Aberrant response to the greater
hemodynamic burden of pregnancy
4. Hormonal interactions
5. Malnutrition
6. Inflammations and apoptosis

9.  Another study suggests
OXIDATIVE SRESS DURING PREGNANCY
Proteolytic cleavage of prolactin
16 kDa prolactin
CARDIOTOXIC
IMPAIR CARDIOCYTE
METABOLISM AND
CONTRACTILITY

10.  BROMOCRIPTINE therapy has been suggested
because it inhibit prolactin secretion

11.  Anti angiogenic factors-known to be
associated with pre eclampsia-can induce
PPCM

13.  INCIDENCE VARIES
 One study based on nationwide inpatient
sample database the incidence rose from
1/1181 live birth in 2004
1/849 in 2011
 1:300 TO 1:4000 Pregnancie

14.  SIMILAR TO THAT OF BIVENTRICULAR FAILURE
 DYSPNOEA
 ORTHOPNOEA
 COUGH
 PAROXYSMAL NOCTURNAL DYSPNOEA
 PALPITATIONS

15.  Tachycardia
 Cardiac arrythmia
 Pulmonary tales
 Peripheral edema

16.  ENLARGED HEART
 PULMONARY VASCULAR REDISTRIBUTION

17.  Enlargement of all chambers predominantly
LV
 Ejection fraction,C.O-DECREASED
 Pulmonary wedge pressure -increased

18.  Bed rest
 Digitalis
 Diuretics
 Anticoagulant therapy
 Immunosuppressive therapy can be
considered if myocardial biopsy indicates
myocarditis or no improvement after 2 weeks
of standard therapy
 (currently not recommended)

20.  50% RECOVER BASELINE VENTRICULAR
FUNCTION WITHIN 6 MONTHS
 BUT IN THOSE WITH PERSISTENT CARDIAC
DYSFUNCTION MORTALITY RATE-85% OVER 5
YRS

21.  RISK OF RECURRENCE-21% in whom LV
function returns to normal,44% in those who
have persistent LV dysfunction