PERIPARTUM

CARDIOMYOPATH
Y

WESLEY

-COMPRISES 4 % OF ALL
CARDIOMYOPATHIES
-1:3000-4000 PREGNANCIES
-9% CAUSE OF MATERNAL
MORTALITY (CDC
SURVEILLANCE)
-DILATED CARDIOMYOPATHY

Definition
Development of heart failure in the
last month of pregnancy and 5
months postpartum in the absence
of a known cause and without any
heart disease prior to the last month
of pregnancy.

Pearson Criteria
Development of cardiac failure in the last month of pregnancy or within 5 months after delivery,
Absence of an identifiable cause for the cardiac failure,
Absence of recognizable heart disease prior to the last
month of pregnancy,
Left ventricular systolic dysfunction demonstrated by
classic echocardiographic criteria, such as depressed
ejection fraction or fractional shortening along with a
dilated left ventricle

Etiology
-viral myocarditis
-abnormal immune response to
pregnancy
-abnormal response to the
increased hemodynamic burden
of pregnancy
-hormonal
-malnutrition
-oxidative stress

Risk Factors
Multiple pregnancy
Pregnancy complicated by
hypertension
Multiparity
Advanced maternal age
Afro-Caribbean race.

Symptoms
Dyspnea
Palpitations
Pulmonary and/or peripheral
edema
Symptoms relating to peripheral or
cerebral emboli
Tachycardia
Congestive cardiac failure

 Dysrhythmias
Signs of pulmonary, cerebral
and systemic embolization
Systemic embolism occurs in
25-40% of those affected by
peripartum cardiomyopathy,
and ischemic stroke in about
5%.

Diagnosis
This requires echocardiography. The diagnostic
criteria are :
6

Left ventricular ejection fraction (LVEF) < 45%

Fractional shortening < 30%
Left ventricular end-diastolic pressure (LVDP) > 2.7 cm/m

Histopathology

Post mortem morphology

Echo

Echo

Management

Elective delivery, if antenatal

Thromboprophylaxis. Anticoagulants are mandatory if there
is severely impaired left ventricular dysfunction, intracardiac
thrombus or arrhythmias
Conventional treatment for heart failure including diuretics,
vasodilators (hydralazine and/or nitrates), cardioselective blockers (bisoprolol) or -blockers with arteriolar
vasodilation action (carvedilol, digoxin, inotropes and, after
delivery, angiotensin enzyme (ACE) inhibitors
Cardiac transplantation may be the only option in severe
cases unresponsive to conventional and full supportive
management.

Prognosis and
Recurrence

Maternal mortality rate is reported to be 20-50%

About 50% of patients make spontaneous and full
recovery
Prognosis depends on normalization of left ventricular
size and function within 6 months after delivery
Women should be counselled against further pregnancy
if left ventricular size or function does not return to
normal, since there is a significant risk of recurrence,
worsening heart failure (50%) and death (25%) in
subsequent pregnancies
For those whose cardiomyopathy resolves, the
recurrence risk is not known but appears to be lower (025%).

REFERENCES
-Williams Obstetrics 24th edition
-Principles and practice of obstetrics
and gynecology for post graduates
-Ain shams journal of anesthesiology
-NEJM
-Harrisons principles of Internal
Medicine

THANK YOU