Epidemiology

Demographics

• Incidence
  • US: 1/2289 to 1/4000 liver births
  • Haiti: 1/299 live births
  • Nigeria: higher incidence than the US
• Parity
  • Most Cases Occur During the First/Second Pregnancy
• Race
  • In the US, Patients of African Descent with Postpartum Cardiomyopathy are Younger, Have a Higher Incidence of Gestational Hypertension, Have Lower Rate of Recovery of Ventricular Function, Have More Severe Disease, and May Have Higher Mortality Rate, as Compared to White Patients with Postpartum Cardiomyopathy ( J Card Fail, 2013) [MEDLINE]

Risk Factors

• Age >30 y/o
• African Ancestry
• Cocaine Abuse (see Cocaine, [[Cocaine]]) (Am J Cardiol, 1992) [MEDLINE]
  • However, Cocaine-Induced Cardiomyopathy is Considered a Distinct Disorder
• History of Preeclampsia/Eclampsia/Postpartum Hypertension (see Pre-Eclampsia, Eclampsia, [[Pre-Eclampsia, Eclampsia]])
  • However, Hypertension-Induced Cardiomyopathy is Considered a Distinct Disorder
• Long-Term Tocolytic Therapy with β-Adrenergic Agonists (Terbutaline) (see Terbutaline, [[Terbutaline]])
• Lower Socioeconomic Status
• Obesity (see Obesity, [[Obesity]])
• Pregnancy with Multiple Fetuses
• Selenium Deficiency (see XXX): controversial risk factor

---

Physiology

• Unclear Pathogenesis With Multiple Proposed Mechanisms
  • Altered Prolactin Processing
  • Cytokines
  • Imbalance in Vascular Endothelia Growth Factor (VEGF)
  • Myocarditis (see Myocarditis, [[Myocarditis]])

---

Diagnosis

Serum Brain Natriuretic Peptide (BNP) (see Serum Brain Natriuretic Peptide, [[Serum Brain Natriuretic Peptide]])

• Elevated (see Elevated Serum Brain Natriuretic Peptide, [[Elevated Serum Brain Natriuretic Peptide]])

Echocardiogram (see Echocardiogram, [[Echocardiogram]])

• Standard First Diagnostic Test

Swan-Ganz Catheter (see Swan-Ganz Catheter, [[Swan-Ganz Catheter]])

• xxxx

Cardiac Catheterization (see Cardiac Catheterization, [[Cardiac Catheterization]])

• Only Required in Cases Where Coronary Artery Disease Needs to Be Ruled Out

---

Clinical Manifestations

General Comments

• Postpartum Cardiomyopathy Rarely Presents Before 36 wks of Pregnancy
  • Most Cases Present During the First Month Postpartum

Cardiovascular Manifestations

• Systolic Congestive Heart Failure (CHF) (see Congestive Heart Failure, [[Congestive Heart Failure]])
  • Clinical
    • Cough (see Cough, [[Cough]])
    • Dyspnea (see Dyspnea, [[Dyspnea]])
    • Elevated Jugular Venous Pressure (JVP)
    • Orthopnea (see Orthopnea, [[Orthopnea]])
    • Paroxysmal Nocturnal Dyspnea (see Paroxysmal Nocturnal Dyspnea, [[Paroxysmal Nocturnal Dyspnea]])
    • Peripheral Edema (see Peripheral Edema, [[Peripheral Edema]])
    • Pulmonary Edema (see xxxx, [[xxxx]])
      • Crackles
    • S3 (Third Heart Sound)

Other Manifestations

• xxx

---

Treatment

Pharmacologic Management

• Bromocriptine (Parlodel) (see Bromocriptine, [[Bromocriptine]])
  • Pharmacology: inhibits activity of prolactin
• Specific Medications to Be Avoided During Pregnancy
  • Angiotensin Converting Enzyme Inhibitors (ACE-I) (see Angiotensin Converting Enzyme Inhibitors, [[Angiotensin Converting Enzyme Inhibitors]])
  • Angiotensin II Receptor Antagonists (ARB’s) (see Angiotensin II Receptor Antagonists, [[Angiotensin II Receptor Antagonists]])

Automatic Implantable Cardioverter-Defibrillator (AICD) (see Automatic Implantable Cardioverter-Defibrillator, [[Automatic Implantable Cardioverter-Defibrillator]])

• Decision Regarding Placement Should Be Made After 60 mo Postpartum: since cardiac function generally improves over time

Cardiac Transplant (see Cardiac Transplant, [[Cardiac Transplant]])

• Cardiac Transplantation Rate in Peripartum Cardiomyopathy: 6-11% of case

---

Prognosis

• Mortality Rate: 0-19%
• Poor Prognostic Factors
  • EF <25%
  • Advanced Age
  • Black Race
  • Low Socioeconomic Status
  • Multiparity

---

References

• Postpartum cardiomyopathy associated with maternal cocaine abuse. Am J Cardiol. 1992;70(11):1092 [MEDLINE]
• Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail. 2010;12(8):767 [MEDLINE]
• Clinical characteristics of peripartum cardiomyopathy in the United States: diagnosis, prognosis, and management. J Am Coll Cardiol. 2011;58(7):659-670 [MEDLINE]
• Differences in clinical profile of African-American women with peripartum cardiomyopathy in the United States. J Card Fail. 2013 Apr;19(4):214-8 [MEDLINE]
• Peripartum cardiomyopathy: a review article. Int J Cardiol. 2013 Mar 20;164(1):33-8. doi: 10.1016/j.ijcard.2011.11.069. Epub 2011 Dec 20 [MEDLINE]
• Peripartum cardiomyopathy: definition, incidence, etiopathogenesis, diagnosis, and management. Cardiol Rev. 2015;23(2):69-78 [MEDLINE]