Kristie McNealy, MD

Peripartum cardiomyopathy (PPCM) is a rare yet terrifying condition which results in heart failure in the last month of pregnancy or within 5 months after delivery. Estimates of the prevalence of peripartum cardiomyopathy in the United States vary widely from 1 in 1,300 to 1 in 15,000 live births. Risk factors for the development of peripartum cardiomyopathy include obesity, a previous history heart problems, smoking and alcoholism, but many times, the cause is unknown and no risk factors are present. PPCM is a life threatening condition which can often go misdiagnosed, and suspected cases require prompt and thorough medical evaluation.

Symptoms

At first, mild symptoms of peripartum cardiomyopathy, like shortness of breath and swelling can mimic the symptoms of normal pregnancy and other pregnancy related conditions like pre-eclampsia. However, women with new or rapid onset of cough, shortness of breath when lying down (orthopnea), severe shortness of breath that awakes them at night (paroxysmal nocturnal dyspnea), palpitations or chest pain should be evaluated by a doctor immediately for signs of heart failure. Medical signs of peripartum cardiomyopathy include a rapid heart rate, abnormal heart sounds, low oxygen saturation and worsening swelling in the extremities.

Diagnosis

If a woman is suspected of having peripartum cardiomyopathy, a chest x-ray will often be ordered to rapidly check for fluid in the lungs and to look at the size of the heart. Other tests which may be ordered include an electrocardiogam (ECG or EKG) to look at electrical activity of the heart, and an echocardiogram to look at the size of the heart, the motion of the heart muscle and how well blood is being pumped out of the left ventricle.

Prognosis

While peripartum cardiomyopathy once had a mortality rate of 25-50%, proper treatment (see Dr. Fett’s note in the comments section below) has brought the mortality rate down to 5% in the US.  If PPCM develops before delivery, reduced blood flow and oxygen can cause damage to the fetus. While some women deteriorate rapidly and others lose heart function gradually, women who’s hearts return to normal size and function have the best prognosis. At this time, there is no way to determine which women will recover, and which will go into heart failure and require a heart transplant in order to survive.

According to a letter by Dr. James Fett, a recognized expert in the field of PPCM, “for women who have experienced recovery of systolic heart function after a diagnosis of PPCM, there is a relatively low relapse rate in the next subsequent pregnancy.” But, if you find yourself considering another baby after suffering from PPCM, you should still consult with your doctors first. This will give you and your family a better understanding of the risks and management of future pregnancies, and help you build a relationship and plan with your caregivers in advance. Being prepared and receiving early and regular prenatal care will give you and your baby the best shot at a healthy pregnancy and safe delivery.

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