Download Peripartum Cardiomyopathy

Peripartum Cardiomyopathy
5/10/10
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= dilated cardiomyopathy of unknown cause that occurs in the peripartum period
- rare (1 in 15,000 deliveries)
- fatal in up to 50% of patients
- survivors -> exercise impairment and may require heart transplant
- ?myocarditis from virus or autoimmune mediated
- ?immune reaction to fetal cells -> migration to myocardium -> provocation of an immune
response
DEFINITION
= echo evidence of idiopathic cardiomyopathy +
(1) that occurs during a 6 month period peripartum
(2) is a new diagnosis
(3) other identifiable causes excluded
HISTORY
- failure symptoms
EXAMINATION
- heart failure
INVESTIGTATIONS
- ECHO: LV dysfunction and normal valves
- endocardial biopsy
MANAGEMENT
- many therapies are teratogenic or effect fetus (Consult a Obstetric Physician)
- reduce preload (Na+ and fluid restriction, diuretics)
- reduce afterload (ACE inhibitors, amilodpine)
- beta-blockers
- anti-coagulation for those with EF < 20%
- treat with anti-failure medication for 2/52 -> if fails consider immunosuppression
(prednisone + cyclophosphamide or azathioprine)
- mechanical support: IABP, VAD
- cardiac transplantation
Jeremy Fernando (2011)