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Peripartum Cardiomyopathy

What is peripartum cardiomyopathy?

Peripartum cardiomyopathy is a rare type of heart failure. It occurs during pregnancy or immediately after delivery. The condition weakens the heart muscle and causes the heart to become enlarged. As a result, the heart can’t pump blood properly to the rest of the body.

According to the American Heart Association, this heart condition affects about 1,000 to 1,300 women in the United States each year. Women usually receive a diagnosis during the last month of their pregnancies or within five months of delivery.

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Causes

What are the causes of peripartum cardiomyopathy?

Your heart pumps up to 50 percent more blood during pregnancy. This is because you have to transfer oxygen and vital nutrients to your growing baby. There’s no definitive cause of peripartum cardiomyopathy. However, doctors believe this condition occurs when the extra pumping of blood combines with other risk factors. This combination places additional stress on the heart.

Risk Factors

Who is at risk for peripartum cardiomyopathy?

A variety of risk factors can increase your chances of developing this condition, including:

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Symptoms

What are the symptoms of peripartum cardiomyopathy?

Symptoms of peripartum cardiomyopathy are similar to symptoms of heart failure. You may experience:

  • rapid heartbeat or palpitations
  • chest pain
  • excessive fatigue
  • tiredness during physical activity
  • shortness of breath
  • swelling of feet and ankles
  • increased urination at night

Diagnosis

How is peripartum cardiomyopathy diagnosed?

Your doctor will review your symptoms and perform a physical exam. A device called a stethoscope may be used to help the doctor listen for crackling noises in the lungs and abnormal sounds in the heart. Your doctor will also test your blood pressure. It may be lower than normal and could drop significantly when you stand up.

A variety of imaging tests can measure your heart. These tests also determine the rate of blood flow. Some of these imaging tests can also view potential lung damage. Tests may include:

  • X-ray of the entire chest
  • CT scan for detailed pictures of the heart
  • nuclear heart scan to show heart chambers
  • sound waves to create moving pictures of the heart (echocardiogram)
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Treatment

What are the treatment options for peripartum cardiomyopathy?

Women who develop this condition remain in the hospital until their symptoms are under control. And your doctor will recommend treatment based on the severity of your condition. Peripartum cardiomyopathy heart damage is irreversible. But, a damaged heart can still function for a long time, depending on the severity of the damage. The severity of the damage will also determine whether a heart transplant is needed.

The outlook for women diagnosed with peripartum cardiomyopathy is good for those whose hearts return to normal size after delivery. This happens for between 30-50 percent of women. In all cases, 4 percent of patients require a heart transplant, and 9 percent die as a result of the heart transplant procedure.

Doctors recommend a heart transplant or a balloon heart pump in severe cases. For most women, however, treatment involves managing and reducing symptoms.

Your doctor may prescribe the following medications to control your symptoms:

  • beta-blockers: drugs that reduce blood pressure and improve blood flow by blocking the adrenaline hormone
  • digitalis: drugs that strengthen the heart to improve pumping and circulation
  • diuretics: drugs that lower blood pressure by removing excess water and salt from the body

Women with this condition may also need to follow a low-salt diet to manage their blood pressure. They should avoid alcohol and tobacco products entirely. These products can make symptoms worse.

Peripartum cardiomyopathy can affect your health for the rest of your life, even after successful treatment. Follow through with regular checkups and take all medications as directed.

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Complications

What are the complications associated with peripartum cardiomyopathy?

Severe complications include:

  • arrhythmia
  • blood clots, particularly in the lungs
  • congestive heart failure
  • death
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Prevention

How can I prevent peripartum cardiomyopathy?

Certain lifestyle habits can decrease your risk. This is especially important for first time mothers. Focus on:

  • getting regular exercise
  • eating a low-fat diet
  • avoiding cigarettes
  • avoiding alcohol

Women who receive a diagnosis of peripartum cardiomyopathy are at risk for developing the condition with future pregnancies. In these cases, women may consider taking birth control to prevent pregnancies.

Outlook

What is the long-term outlook?

The outlook for this condition depends on the severity and time frame of your condition. Some women who develop the condition during pregnancy may have their hearts return to normal size after delivery. For others, their condition can continue to worsen. In these cases, a heart transplant may be the best way to preserve longevity.

Article resources
  • Givertz MM. (2013). Peripartum cardiomyopathy. https://doi.org/10.1161/CIRCULATIONAHA.113.001851
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