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What is Peripartum Cardiomyopathy?
Peripartum cardiomyopathy (PPCM) is a form of systolic heart failure that develops in the last month of pregnancy or within five months after delivery. It occurs when no other cause of heart failure can be identified. Your heart chambers, particularly the left ventricle, enlarge and weaken, reducing the heart’s ability to pump blood effectively. This condition is also known as postpartum cardiomyopathy or pregnancy-associated cardiomyopathy.The condition is rare but can range from mild to severe. A key measure of severity is the left ventricular ejection fraction (LVEF), which shows how much blood your heart pumps out with each beat. A normal LVEF is 50 to 70 per cent, but in PPCM, it drops below 45 per cent.
Symptoms of Peripartum Cardiomyopathy
The symptoms of postpartum cardiomyopathy can be difficult to notice because they often mimic normal pregnancy discomforts. Reach out to your healthcare professional if you experience any of these:- Shortness of breath, especially during light activity or when lying flat.
- Fatigue that feels overwhelming.
- Fluid retention leading to swollen ankles, feet, or legs, and sometimes a cough or chest congestion.
- Increased need to urinate at night due to fluid buildup.
- Chest pain or tightness.
- Heart palpitations, a sensation of your heart racing or skipping beats.
- Lightheadedness or feeling like you might faint.
Causes of Peripartum Cardiomyopathy
Peripartum cardiomyopathy does not have a single definitive cause. Researchers are still working to understand why this happens to some individuals. But several possibilities are being explored, which may include:- Hormonal changes during pregnancy.
- Prior viral or bacterial infections.
- Nutritional deficiencies might weaken the heart.
- Hemodynamic stress, or the strain pregnancy puts on your heart.
- An abnormal immune response could trigger the condition.
- Genetics may be involved, as 20 per cent of women with PPCM have genetic mutations linked to cardiomyopathy. But most individuals with PPCM have no family history of heart disease.
Risk Factors for Peripartum Cardiomyopathy
A few risk factors increase your chances of developing this condition. These can be divided into factors before and during pregnancy:Before Pregnancy
- Being over 35 years old.
- High blood pressure or a history of heart disease.
- Smoking or excessive alcohol consumption.
- Obesity.
- Selenium and zinc deficiency.
During Pregnancy
- Being pregnant for the first time.
- Carrying twins or triplets.
- A previous diagnosis of postpartum cardiomyopathy.
- Use of assisted reproductive technology, like in vitro fertilisation (IVF), to get pregnant.
- Preeclampsia or gestational hypertension which involves high blood pressure.
- Anaemia.
Complications of Peripartum Cardiomyopathy
Serious and potentially life-threatening complications associated with this condition may include:- Irregular heart rhythms (arrhythmias).
- Cardiogenic shock (a condition where the heart suddenly can't pump enough blood).
- Heart failure.
- Complications caused by blood clots.
- Neurological damage.
Diagnosis of Peripartum Cardiomyopathy
Diagnosing peripartum cardiomyopathy can be challenging because its symptoms overlap with those of late pregnancy. Your doctor will use a combination of criteria and tests to confirm the condition. An early diagnosis is important to improve your chances of recovery.Diagnostic Criteria
- Heart failure develops in the last month of pregnancy or within five months after delivery.
- No other cause for heart failure can be found.
- Your LVEF is less than 45 per cent, as measured by tests like an echocardiogram.
Tests for Diagnosis
- A physical exam to check for fluid in your lungs, rapid heart rate, or abnormal heart sounds.
- Chest X-ray to look for an enlarged heart or fluid in the lungs.
- Echocardiogram, using sound waves to show your heart’s motion and size.
- Electrocardiogram (ECG) to measure electrical signals and detect irregularities.
- Blood tests to check kidney, liver, thyroid function, and complete blood count for anaemia or infection.
- Brain natriuretic peptide (BNP) and N-terminal pro-BNP tests to assess cardiac injury and stress.
- Cardiac catheterisation to measure pressure in heart chambers and blood flow.
- Treadmill stress test to monitor heart rhythm, breathing, and blood pressure during exercise.
Your doctor will also review your health and family history to rule out other heart conditions or genetic factors.
Treatment of Peripartum Cardiomyopathy
Its treatment focuses on managing heart failure symptoms and helping your heart recover. Your healthcare professional will make sure that any medications used are safe during pregnancy or while breastfeeding.Medications
- Angiotensin-converting enzyme (ACE) inhibitors. These are generally considered safe to use in the postpartum period but not during pregnancy.
- Beta blockers to slow your heart rate and help recovery.
- Diuretics to reduce fluid retention in your lungs, legs, or abdomen.
- Digitalis to strengthen heart pumping, though used less often due to safety concerns.
- Anticoagulants to thin blood and prevent clots, especially if LVEF is very low.
- Inotropic therapies for advanced heart failure in intensive care.
Peripartum Cardiomyopathy Recovery
Your recovery depends on factors like your LVEF at diagnosis and how well treatment works. Many individuals see improvement, but the timeline and outcome vary.- Recovery typically occurs between 3 and 6 months after childbirth, but in some cases, it may take up to 48 months postpartum.
- You’ll likely need to continue medications for at least a year after recovery.
- Full recovery is defined as an LVEF of 50 to 55 per cent or higher, checked six months after diagnosis.
- Even after recovery, some individuals may face a heart failure relapse later.
Can Peripartum Cardiomyopathy Be Prevented?
No, it cannot be entirely prevented, but you can take certain measures to keep your heart healthy and lower your risk:- Manage high blood pressure with regular exercise and a balanced diet.
- Avoid smoking and alcohol completely.
- Eat a low-salt diet to reduce fluid buildup.
- Move daily to support heart health.
- If you’ve had PPCM before, discuss risks with your doctor before planning another pregnancy.
- Consider contraception options if another pregnancy poses too high a risk.
Future Pregnancies and Peripartum Cardiomyopathy
If you have previously had peripartum cardiomyopathy, future pregnancies may carry increased risks. Your safety depends on how well your heart has recovered.- If your heart function hasn’t fully returned to normal, another pregnancy isn’t recommended due to potential harm to you and your baby.
- You may try for another pregnancy if your heart has fully recovered. But you will need regular echocardiograms and stress tests to monitor your heart.
- Even with a healthy heart, the risk of PPCM recurring is higher.
- Avoid oestrogen-based contraception, as it increases your risk of blood clots. Discuss safe options with your doctor.
Peripartum cardiomyopathy is a serious condition that needs early attention. If you have had PPCM before, discuss future pregnancies carefully with your doctor, follow their advice, and stay alert to any changes in how you feel. Many individuals recover and lead healthy lives with the right care.
FAQs on Peripartum Cardiomyopathy: Symptoms, Diagnosis, and Treatment
- How is peripartum cardiomyopathy diagnosed?
Doctors use tests like echocardiograms, chest X-rays, ECG, and blood tests to check your heart’s function and rule out other causes. - Can peripartum cardiomyopathy be prevented?
It cannot be completely prevented, but managing blood pressure, avoiding smoking and alcohol, and living a healthy lifestyle can lower your risk. - How long does peripartum cardiomyopathy recovery take?
Recovery varies but often happens within 3 to 6 months after childbirth. Some may take longer or need ongoing treatment.
