High risk and low incidence diseases: Peripartum cardiomyopathy

Peripartum cardiomyopathy (PPCM) is a serious condition that carries with it a high rate of morbidity and mortality.

This review highlights the pearls and pitfalls of peripartum cardiomyopathy, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.

PPCM presents in the last month of pregnancy and up to five months postpartum. The presentation is similar to other forms of heart failure with fatigue, dyspnea on exertion, and lower extremity edema, but these mimic many other symptoms typical of pregnancy. Therefore, emergency physicians must consider PPCM in appropriate scenarios. Evaluation includes an echocardiogram, laboratory studies, electrocardiogram, and chest x-ray. While PPCM is a diagnosis of exclusion, evidence of left ventricular dysfunction is required for diagnosis. B-type natriuretic peptide (BNP) carries high sensitivity if elevated, but this is not specific to PPCM. Management focuses on afterload reduction and preload optimization utilizing nitrates and loop diuretics which are both safe intrapartum and postpartum. Noninvasive positive pressure ventilation is helpful for those with pulmonary edema and respiratory distress. Early consultation with obstetrics-gynecology and cardiology specialists can assist with determining further interventions and disposition.

An understanding of PPCM can assist emergency physicians in diagnosing and managing this potentially deadly disease.