Peripartum Cardiomyopathy

It is critical that the diagnosis of peripartum cardiomyopathy is limited to women with congestive heart failure and decreased systolic function of the left ventricle in last month of pregnancy or within 5 months after delivery. Patients must have no pre-existing cardiac disease and no other cause for current cardiac dysfunction. The inclusion of patients before the last month of pregnancy or after 5 months postpartum introduces a large number of patients with cardiac disorders due to causes other than peripartum cardiomyopathy. Ventricular performance at rest and with exertion determines the type of management, its intensity, and duration. Patients whose ventricular function is normal at rest and with exercise or dobutamine can have their heart failure therapy tapered and ultimately discontinued after 6 to 12 months of standard treatment. Those with normal resting but abnormal stress cardiac function should continue some form of medical therapy (afterload reduction or beta-blocker) for longer periods of time, if not for life. Those with persistently abnormal ventricular function must receive optimal heart failure therapy forever and face the same relatively poor prognosis as patients with dilated cardiomyopathy from any cause. Options for management include standard heart failure therapy (digoxin, diuretics, afterload reduction, and anticoagulation), Swan-Ganz catheter monitoring and use of inotropic agents, intra-aortic balloon counterpulsation, and left ventricular assist device. Patients with peripartum cardiomyopathy are candidates for heart transplantation, assuming they meet all other criteria.