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RadhakRishnan RamaRaj, mdDepartment of Internal Medicine, University ofArizona College of Medicine, Tucson, AZ

Vincent L. soRReLL, mdProfessor of Clinical Medicine, Pediatrics, andRadiology, The Allan C. Hudson and Helen LovaasEndowed Chair of Cardiovascular Imaging, Sectionof Cardiology, University of Arizona Sarver HeartCenter, Tucson, AZ

Peripartum cardiomyopathy:Causes, diagnosis, and treatment

AbstrAct

Peripartum cardiomyopathy is a life-threatening condi-

tion of unknown cause that occurs in previously healthywomen during the peripartum period. It is characterizedby left ventricular dysfunction and symptoms of heartfailure that can arise in the last trimester of pregnancyor up to 5 months after delivery. We review its possiblecauses and how to recognize and manage it.

KEY POINts

Heightened suspicion is important when a pregnantwoman presents with signs of heart failure, becauseearly diagnosis allows proven treatment to be started.

Standard heart failure therapy should be started in post-partum patients with this disease, using available localprotocols.

Pregnant women should not receive angiotensin-con-verting enzyme inhibitors, angiotensin receptor blockers,or warfarin because of potential teratogenic effects.

An initial left ventricular end-systolic dimension less than

5.5 cm, a left ventricular ejection fraction greater than30%, and a low cardiac troponin level may predicta better outcome.

Subsequent pregnancies carry a high risk of relapse,even in women who have fully recovered leftventricular function.

CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 76 NUMBER 5 MAY 2009 289

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mEdIcAl PrOblEms IN PrEgNANcY

doi:10.3949/ccjm.76a.08004

EDUCATIONAL OBJECTIVE: Readers will suspect peripartum cardiomyopathy in patients who developunexplained heart ailure symptoms during the peripartum periodCREDIT

CME

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290 CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 76 NUMBER 5 MAY 2009

PErIPArtum cArdIOmYOPAthY

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h o h .44

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o h s o bo.56,57

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aben

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rAmArAJ ANd sOrrEll

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62

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natuRal cOuRse

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unexplained

ympom of

hear failure

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In pregnancy,

we mu alo

conider he

welfare of he

feu

moh s s o h oh sz o om wh 6 mohs, sossb h v o mo o ov bo 6 mohs,

h ss o m hsos o hs.54

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v ws 40%, om wh h o o 30.2%.

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PROgnOstIc actORs

Troponin T. H 41 o h hsm oo T oo m s 2 wks h os o momoh o vs wh h v jo o 6 mohs.Howv, h ssv ws ow: oo Too o mo h 0.04 /mL ss v so wh ssv o o 55%. Th s ws91%. QRS duration o 120 ms o mo hs b s o o h. PooQRS o hs b show o b sk o o h s h ss o s wh shm oshm .77

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I osv s,79 osho o 20% o mo v

so mso o 6 m o mo

h m o oss s h sk o ss v so ho.Oh os ssssm ssowh k o ov w v

so mso h 5.6 m, v hombs, A Am .6

RIsK O RelaPse

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wos h o msso so.80

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I h U Ss, Ekm 82 44 wom wh m omo h who bm . O hs, 28h ov sso o, wh joos o 50% o hh bo bom , 16 h o. Th joo boh os h sbs q , b h s o b mo h 20% o 6 (21%), o. I os, h so o bmo h 20% 5 (31%), 3 (19%) .

Ps who ov om v o hv om v o sv obmh m k oh s, b h sho b w o h sk o v wh ov v o.46,82

Dob 83 om obmsss hooh o ms mxmoo o sv sx woms wh m omoh, o wh sbsqov o v o.

Bs o hs , o ommoso h s h oow:

I v o hs ov, sbsq s o o

, b h sho b

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rAmArAJ ANd sOrrEll

o h, hoh h sk s ow, so bs.I v o hs ov , om obm sss

hooh. I h voo sos o obm s o m, h s b os s

bov; h v oo sos o obm s bom, hh sk s mo s oomm.

I v o hs o ov , h sk s hh, sbsq s o omm.

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ADDRESS: Radhakrishnan Ramaraj, MD, Department of Internal Medicine,University of Arizona College of Medicine, 1501 North Campbell Avenue,

Tucson, AZ 85724; E-mail [email protected].

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