Peripartum cardiomyopathy

Peripartum cardiomyopathy is increasingly recognised and diagnosed in clinical practice. Over the past two decades, a substantial amount of new knowledge on this condition has been accrued, including a better understanding of the pathophysiology, genetic predisposition for a proportion of patients, diagnostic tools, management with a disease-specific therapy, and predictors of outcome. Peripartum cardiomyopathy occurs globally in all ethnic groups and should be suspected in any women who are peripartum presenting with symptoms and signs indicative of heart failure towards the end of pregnancy or in the months following delivery. Verification of left ventricular systolic dysfunction (ejection fraction <45%) is crucial for the diagnosis of peripartum cardiomyopathy and the exclusion of other causes of heart failure, such as pre-existing cardiomyopathy, valvular heart disease, or congenital heart disease. Peripartum cardiomyopathy is a disease with considerable maternal and neonatal morbidity and mortality, with only half of women experiencing complete myocardial recovery within 6 months of the onset of symptoms. This Seminar summarises current knowledge of peripartum cardiomyopathy genetics, pathophysiology, diagnostic approaches, medical management, and outcome. Furthermore, we provide guidance on both risk stratification by use of a novel score to predict recovery and on the outcomes of a subsequent pregnancy.