(1)development of heart failure in the last month of pregnancy within 5 months after delivery
(2)absence of a known cause
(3) without any heart disease prior to the last month of pregnancy
(4) documented systolic dysfunction
Advanced maternal age
Dyspnoea/paroxysmal nocturnal dysponea
pulmonary oedema/peripheral oedema
features of peripheral/cerebral embolism
third heart sound
Systemic embolism occurs in 25-40% of patients with cardiomyopathy.
Left ventricular ejection fraction <45%>
Left ventricular end diastolic pressure (LVEDP) >2.7cm/m2
Fractional shortening <30%>Chest Xray-Cardiomegaly/Pleural effusion/patchy lower lung infiltrates vascular redistribution
ECG- may helpful in excluding other causes
Endomyocardial biopsy done some times.
Invasive haemodynamic monitoring is considered if there is not a good response to medical treatment.
Newyork heart association classification can be used
II-mild symptoms or symptoms only with extreme exertion
III-Symptoms on minimal exertion
IV- symptoms at rest Management
conventional treatment for heart failure is generally used.
vasodilators(hydralazine &/ nitrates)
cardio selective beta blockers(bisoprolol) or beta blockers with vasodilating action (carvedilol)
Elective delivery if antenatal.If cervix is favourable vaginal delivery is preferable,otherwise caesarean section may be chosen.Skilled epidural anaesthesia is useful for both routes of delivery.
Immunosuppressive therapy if myocarditis confirmed by endometrial biopsy.
Temporary support can be given by intraaortic balloon pumps & left ventricular assist devices.
Cardiac transplantation is indicated if intractable heart failure persists optimal medical therapy
Breast feeding isn't contraindicated.
Some patients recover rapidly but others may deteriorate to state requiring cardiac transplantation.
50% of patients make full recovery.
Echocardiography is repeated every six months to assess the recovery.
Prognosis depend on recovery of left ventricular size & function within 6 months.
Persistence of cardiac dysfunction beyond 6 months an indication of irreversible damage and such should be advised against pregnancy
Stress echocardiogram using dobutamine can be used to assess the contractile reserve.This would help in pre pregnancy counseling.Recurrence rate has been upto 50%
|1.||Nelson-Piercy C. Handbook of obstetric medicine. Taylor & Francis; 2002.|
|2||Swiet MD. Medical disorders in obstetric practice. Wiley-Blackwell; 2002.|
|4.||Peripartum Cardiomyopathy [Internet]. 2001 May 24 [cited 2009 Dec 12];Available from: http://content.nejm.org/cgi/content/extract/344/21/1629|