title: Peripartum cardiomyopathy: a review.
abstract: Peripartum cardiomyopathy is idiopathic heart failure occurring in the absence of any determinable heart disease during the last month of pregnancy or the first 5 months postpartum. The incidence varies worldwide but is high in developing nations; the cause of the disease might be a combination of environmental and genetic factors. Diagnostic echocardiographic criteria include left ventricular ejection fraction <0.45 or M-mode fractional shortening <30% (or both) and end-diastolic dimension >2.7 cm/m(2). Electrocardiography, magnetic resonance imaging, endomyocardial biopsy, and cardiac catheterization aid in the diagnosis and management of peripartum cardiomyopathy. Cardiac protein assays can also be useful, as suggested by reports of high levels of NT-proBNP, cardiac troponin, tumor necrosis factor-α, interleukin-6, interferon-γ, and C-reactive protein in peripartum cardiomyopathy. The prevalence of mutations associated with familial dilated-cardiomyopathy genes in patients with peripartum cardiomyopathy suggests an overlap in the clinical spectrum of these 2 diseases.Treatment for peripartum cardiomyopathy includes conventional pharmacologic heart-failure therapies-principally diuretics, angiotensin-converting enzyme inhibitors, vasodilators, digoxin, β-blockers, anticoagulants, and peripartum cardiomyopathy-targeted therapies. Therapeutic decisions are influenced by drug-safety profiles during pregnancy and lactation. Mechanical support and transplantation might be necessary in severe cases. Targeted therapies (such as intravenous immunoglobulin, pentoxifylline, and bromocriptine) have shown promise in small trials but require further evaluation. Fortunately, despite a mortality rate of up to 10% and a high risk of relapse in subsequent pregnancies, many patients with peripartum cardiomyopathy recover within 3 to 6 months of disease onset.
authors.affiliation: School of Public Health, The University of Texas, Houston, Texas 77030, USA.
authors.forename: Anirban
authors.initials: A
authors.lastname: Bhattacharyya
authors.forename: Sukhdeep Singh
authors.initials: SS
authors.lastname: Basra
authors.forename: Priyanka
authors.initials: P
authors.lastname: Sen
authors.forename: Biswajit
authors.initials: B
authors.lastname: Kar
mesh_terms: D009202:Cardiomyopathies / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D058725:Peripartum Period; D011237:Predictive Value of Tests; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D011644:Puerperal Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors; D016896:Treatment Outcome