Peripartum Cardiomyopathy
OVERVIEW
- Peripartum Cardiomyopathy = 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 +
- that occurs during a 6 month period peripartum
- is a new diagnosis
- other identifiable causes excluded
CLINICAL FEATURES
History
- failure symptoms
Examination
- heart failure
- pregnancy
INVESTIGATIONS
- 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, amlodipine)
- 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
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC