Cardiomyopathy, Peripartum

Exact incidence unknown

Incidence in USA: About 1:3000 to 1:4000 live births

Incidence higher in African-Americans compared to Caucasians

Highest incidence in Haiti and parts of Africa

CHF

Arrhythmias; atrial and ventricular

Pulm and systemic thromboembolism

Increased myocardial oxygen demand with progression of pregnancy may exceed myocardial oxygen supply resulting in myocardial ischemia.

Autotransfusion associated with uterine contractions during labor and involuted uterus after delivery may significantly increase preload resulting in pulm edema.

Anticoagulation may contraindicate neuraxial anesthesia.

Inadequate pain control during labor will increase sympathetic drive resulting in increased afterload and worsening of cardiac function.

A type of DCM.

All of the following must be present for a diagnosis: cardiac failure in the last mo of pregnancy or within 5 mo postpartum, no identifiable cause of cardiac failure, absence of heart disease prior to the last mo of pregnancy, ECHO evidence of LV systolic dysfunction.

Symptoms and signs of heart failure will often develop insidiously and must be discriminated from normal physiologic changes of pregnancy.

Pt complaints include dyspnea, orthopnea, cough, hemoptysis, malaise, chest or abdominal pain.

Physical findings include peripheral edema, jugular venous distension, crackles on chest auscultation, a third heart sound, and a new onset regurgitant murmur.

CXR will reveal cardiomegaly and pulm edema, while ECG may show arrhythmias with nonspecific ST and T wave changes. Dilated hypokinetic ventricles are seen on ECHO.

Exact etiology is unknown.

Possible etiologies include viral or autoimmune myocarditis, abnormal cytokines, and selenium deficiency.

Abnormal cleavage product of prolactin inducing apoptosis has also been implicated.

African-American ethnicity, advanced maternal age, multiple gestation, and hypertensive diseases of pregnancy are contributing factors.