This form of heart failure may develop toward the end of pregnancy or soon after delivery. Treatment can often help restore normal heart function.

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When heart failure occurs in the final weeks of pregnancy or in the first few months after delivery, it may be diagnosed as postpartum cardiomyopathy (also called peripartum cardiomyopathy).

The condition, if diagnosed during pregnancy, may pose a risk to an unborn baby. For pregnant people, can be a serious, potentially life threatening condition that may cause complications like cardiac arrest, blood clots, and stroke. However, most people with postpartum cardiomyopathy recover.

Postpartum cardiomyopathy (PPCM) is a type of systolic heart failure, meaning that it affects the pumping strength of the left ventricle, the heart’s main pumping chamber. PPCM usually occurs in the last month of pregnancy but may develop up to 4 or 5 months after delivery. If there is no other obvious cause of heart failure or a previous diagnosis of heart failure, then it’s likely that symptoms that first appear during this time indicate PPCM.

With PPCM, the heart’s chambers enlarge, and the heart muscle weakens. This makes it more difficult for the left ventricle to pump enough blood to meet the body’s needs. As a result, you may experience low blood pressure, fatigue, and a buildup of fluid in the lower legs.

The main symptoms of PPCM are like those of other types of heart failure. Some may also be more typical during pregnancy. However, if you are experiencing any of these symptoms, speak with your doctor or healthcare professional immediately.

Symptoms of PPCM include:

  • shortness of breath, either during activity or when lying flat
  • swelling in the ankles or feet caused by fluid buildup (edema)
  • chest pain or tightness
  • coughing
  • fatigue
  • heart palpitations
  • lightheadedness, especially when standing up

Medical experts still don’t know exactly why otherwise healthy individuals develop PPCM. According to the American Heart Association (AHA), research suggests one cause may be the abnormal activity of certain hormones that can damage the vascular system. These are some of the same hormones that are also overactive in people with preeclampsia, which is why it’s another major risk factor for PPCM.

Other possible causes include:

  • abnormal immune system response
  • nutritional deficiency
  • previous viral infection

It’s not always clear why someone develops PPCM, though there are some established risk factors. The risk of PPCM is higher if you are:

  • Black
  • pregnant with more than one fetus (twins, triplets, etc.)
  • over the age of 30 during your pregnancy
  • have a history of preeclampsia and chronic high blood pressure or both

One challenge in diagnosing PPCM is that some of its symptoms are like those many people experience toward the end of their pregnancies, such as shortness of breath and foot and ankle swelling. If these or other symptoms come on suddenly during pregnancy or in the months after delivery, speak with your doctor or healthcare professional right away.

If PPCM is suspected, your doctor will review your symptoms and medical history and listen to your heart and lungs with a stethoscope for signs of unusual heart sounds, a rapid heart rate, and fluid in the lungs. You may also have a chest X-ray to check for fluid in the lungs — a common sign of heart failure.

An echocardiogram, which uses sound waves to produce images of the heart, is also helpful in revealing changes in the heart’s structure and pumping ability. An echocardiogram can help determine the left ventricular ejection fraction or the percentage of blood that is pumped from the left ventricle with every heartbeat. A normal ejection fraction is between 50% and 70%. A left ventricular ejection fraction of less than 45% could be a sign of PPCM.

The main goal of PPCM treatment is to restore healthy heart function and prevent the buildup of fluid in the lungs, lower limbs, and elsewhere in the body. This is usually accomplished through a combination of medications and lifestyle adjustments.

Some of the more common medications prescribed to help ease the stress on your heart include:

  • angiotensin-converting enzyme (ACE) inhibitors
  • angiotensin receptor blockers (ARBs)
  • beta-blockers
  • digitalis
  • diuretics

Because of the heart’s reduced pumping ability, the risk of blood clot formation increases. Individuals with PPCM may be prescribed anticoagulant medications (blood thinners) to reduce blood clot risk.

If the heart failure is severe, you may be prescribed inotropic medications, which affect how much power the heart uses with every contraction.

An experimental medication, bromocriptine, is a type of medication that limits the production of prolactin, a hormone involved in producing milk for nursing. In some people, prolactin changes, creating a toxic hormone fragment that affects heart function. Researchers suspect this fragment is involved in causing postpartum cardiomyopathy. One 2022 review of studies found that bromocriptine was associated with a significantly higher survival rate in people with PPCM. Bromocriptine is still being studied as a treatment for PPCM and may be prescribed.

Some medications are not safe for pregnancy or nursing. Your cardiologist will tailor your medication regimen to your individual circumstances.

Your doctor may recommend heart-healthy lifestyle adjustments like a low sodium diet and a restriction on fluid intake to help manage edema. However, these may not be recommended while you are pregnant.

Your doctor may advise you to weigh yourself daily. Sudden, unexplained weight loss of even a couple of pounds could indicate fluid buildup in the lungs or abdomen that may not be obvious.

It’s not always easy to predict what recovery will look like for everyone who experiences PPCM. With treatment, many people experience a full recovery, while others may develop chronic heart failure requiring a lifetime of care.

A small percentage of people die as a result of PPCM. A 2020 review notes that little research exists on long-term mortality rates associated with PPCM but that studies suggest the two-year mortality rate for PPCM may be anywhere from 0–16% in the United States.

What does postpartum cardiomyopathy feel like?

Mild cases of PPCM may have no obvious symptoms, but in more serious cases, you may wake up in the night coughing or having trouble catching your breath. You may experience chest pain or discomfort or have a racing heart. You may experience serious complications such as cardiac arrest, blood clots, or stroke.

How long can postpartum cardiomyopathy last?

PPCM can become chronic heart failure, meaning it lasts a lifetime. Over time, you may need an artificial pump to help the heart do its job or even a heart transplant if the heart is too weak to function. However, the AHA reports that, with treatment, many people with PPCM recover completely within 3–6 months.

How common is heart failure after giving birth?

Postpartum cardiomyopathy is an uncommon condition. A 20-year study of postpartum cardiomyopathy in Europe suggests that about one out of 4,950 pregnant individuals experience PPCM. Another study found that rates vary from 1 in 1,000 pregnancies to 1 in 4,000 In the United States, but they feel the true rate may be unknown.

Postpartum cardiomyopathy is a rare but serious condition that can lead to lifelong complications and health risks. If you are diagnosed with PPCM, it’s important to follow your healthcare team’s advice and take your medications strictly as prescribed.

Because future pregnancies may pose greater health risks, work closely with your doctors if you are planning another pregnancy. If you do become pregnant again, you may need to have frequent monitoring of your heart function to identify any early signs of PPCM or other cardiac concerns.