Peripartum cardiomyopathy

Peripartum cardiomyopathy (PPCM) is a rare, idiopathic, life-threatening disease of late pregnancy and early puerperium, occurring in patients with previously healthy hearts. Risk factors include multiparity, age>30 years, African American race, multiple pregnancies, obesity, hypertension, and toxemia. Signs and symptoms of PPCM resemble systolic heart failure, and it is diagnosed by exclusion. An echocardiogram typically reveals an ejection fraction of <45% and/or fractional shortening of <30%, along with a left ventricular end-diastolic dimension>2.7 cm/m2 of body surface area. Early diagnosis and treatment are important for a successful outcome. Management is similar to other forms of systolic heart failure. Patients with PPCM are at high risk of thromboembolism, and therefore anticoagulation therapy should be considered. The prognosis is variable, ranging from complete recovery, to worsening heart failure requiring cardiac transplantation, or death. Future pregnancies are often discouraged because of the high mortality rate and risk of recurrence.