Methamphetamine Associated Cardiomyopathy in Pregnancy: The Distinctions and the Implications

Methamphetamine associated cardiomyopathy (MAC) and peripartum cardiomyopathy (PPCM) are both rare obstetric conditions. Literature regarding methamphetamine associated cardiomyopathy in the obstetric population is limited, and it can be difficult to make the distinction between the two given the similarities in clinical presentation. However similar, there are significant distinctions in the pathophysiology of these two that can help clinicians with the management process.

This case involves a 35-year-old Hispanic G6P5005 at 37 weeks gestation presenting with acute respiratory failure secondary to acute decompensated heart failure with reduced ejection fraction and superimposed preeclampsia leading to urgent cesarean section. The patient's course was also complicated by chronic methamphetamine use with a possible withdrawal component, which resulted in rapid sequence intubation and mechanical ventilation. Ultimately the patient's respiratory and cardiac symptoms resolved with appropriate treatment. Resolution of reduced ejection fraction was also demonstrated by repeat echocardiogram.

In this article, we will compare the pathophysiology, diagnostic criteria, treatment and prognosis of MAC, specifically in pregnancy, versus PPCM. We also discuss how we ultimately conclude that a diagnosis of MAC can be made rather than PPCM or stress cardiomyopathy. We also find that studies involving methamphetamine use in pregnancy are limited, and ultimately more longitudinal data is needed to achieve a better understanding of patient outcomes, especially given the increasing prevalence of methamphetamine use in the United States.