Peripartum cardiomyopathy.

Tc Okeke, Cct Ezenyeaku, Lc Ikeako
Author Information
  1. Tc Okeke: Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu, Nigeria.

Abstract

Peripartum cardiomyopathy (PPCM) is a rare form of unexplained cardiac failure of unknown origin, unique to the pregnant woman with highly variable outcome associated with high morbidity and mortality. PPCM is fraught with controversies in its definition, epidemiology, pathophysiology, diagnosis and management. PPCM is frequently under diagnosed, inadequately treated and without a laid down follow-up regimen, thus, the aim of this review. Publications on PPCM were accessed using Medline, Google scholar and Pubmed databases. Relevant materials on PPCM, selected references from internet services, journals, textbooks, and lecture notes on PPCM were also accessed and critically reviewed. PPCM is multifactorial in origin. It is a diagnosis of exclusion and should be based on classic echocardiographic criteria. The outcome of PPCM is also highly variable with high morbidity and mortality rates. Future pregnancies are not recommended in women with persistent ventricular dysfunction because the heart cannot tolerate increased cardiovascular workload associated with the pregnancy. Although, multiparity is associated with PPCM, there is an increased risk of fetal prematurity and fetal loss. PPCM is a rare form of dilated cardiomyopathy of unknown origin, unique to pregnant women. The pathophysiology is poorly understood. Echocardiography is central to diagnosis of PPCM and effective treatment monitoring in patients of PPCM. The outcome is highly variable and related to reversal of ventricular dysfunction.

Keywords

References

  1. Curr Heart Fail Rep. 2008 Dec;5(4):238-44 [PMID: 19032920]
  2. Crit Care. 2011;15(2):R93 [PMID: 21392383]
  3. Am J Obstet Gynecol. 2008 Oct;199(4):e5-6 [PMID: 18928969]
  4. Circulation. 1971 Dec;44(6):1053-61 [PMID: 4256828]
  5. J Heart Lung Transplant. 1994 Mar-Apr;13(2):202-7 [PMID: 8031800]
  6. Int J Cardiol. 1993 Jun 15;40(1):57-65 [PMID: 8349367]
  7. Eur Heart J. 2008 Jan;29(2):270-6 [PMID: 17916581]
  8. Curr Treat Options Cardiovasc Med. 2004 Dec;6(6):481-488 [PMID: 15496265]
  9. Circulation. 2005 Apr 26;111(16):2050-5 [PMID: 15851613]
  10. Am J Obstet Gynecol. 1993 Feb;168(2):493-5 [PMID: 8438916]
  11. Q J Med. 1978 Oct;47(188):431-61 [PMID: 751087]
  12. Obstet Gynecol. 2005 Jun;105(6):1303-8 [PMID: 15932821]
  13. Monaldi Arch Chest Dis. 2008 Mar;70(1):15-23 [PMID: 18592937]
  14. Int J Cardiol. 1992 Jul;36(1):57-9 [PMID: 1428253]
  15. Circulation. 2010 May 25;121(20):2169-75 [PMID: 20458010]
  16. N Engl J Med. 1996 May 23;334(21):1349-55 [PMID: 8614419]
  17. Circulation. 2009 Apr 14;119(14):1977-2016 [PMID: 19324967]
  18. J Am Coll Cardiol. 2008 May 27;51(21):2083; author reply 2083-4 [PMID: 18498970]
  19. Postgrad Med J. 2011 Jan;87(1023):34-9 [PMID: 20935342]
  20. J Am Coll Cardiol. 2000 Mar 1;35(3):701-5 [PMID: 10716473]
  21. Best Pract Res Clin Obstet Gynaecol. 2008 Oct;22(5):825-46 [PMID: 18775679]
  22. Crit Care Clin. 2004 Oct;20(4):777-88, xi [PMID: 15388202]
  23. Int J Obstet Anesth. 2009 Apr;18(2):186-8 [PMID: 19200712]
  24. Am J Cardiol. 2007 Jul 15;100(2):302-4 [PMID: 17631087]
  25. Am Heart J. 1991 Jun;121(6 Pt 1):1776-8 [PMID: 2035390]
  26. Int J Clin Pract. 2004 Apr;58(4):363-5 [PMID: 15161121]
  27. J Am Coll Cardiol. 2010 Feb 16;55(7):654-9 [PMID: 20170791]
  28. Arch Gynecol Obstet. 2010 Feb;281(2):183-8 [PMID: 19655159]
  29. Int J Cardiol. 2010 Sep 24;144(1):143-5 [PMID: 19171402]
  30. Int J Cardiol. 2007 Jun 12;118(3):295-303 [PMID: 17208320]
  31. Angiology. 2001 Nov;52(11):759-62 [PMID: 11716328]
  32. Am J Crit Care. 2012 Mar;21(2):89-98 [PMID: 22381985]
  33. Cardiol Rev. 2006 Jan-Feb;14(1):35-42 [PMID: 16371764]
  34. Int J Cardiol. 2009 Jan 9;131(2):168-79 [PMID: 18722678]
  35. Perfusion. 2009 Mar;24(2):75-9 [PMID: 19654146]
  36. Lancet. 2006 Aug 19;368(9536):687-93 [PMID: 16920474]
  37. Am Heart J. 1995 Feb;129(2):421-2 [PMID: 7832124]
  38. Trends Cardiovasc Med. 2008 Jul;18(5):173-9 [PMID: 18790387]
  39. Am Heart J. 1979 May;97(5):613-21 [PMID: 433737]
  40. J Emerg Trauma Shock. 2009 May;2(2):124-8 [PMID: 19561973]
  41. J Am Coll Cardiol. 2005 Apr 5;45(7):969-81 [PMID: 15808750]
  42. Int J Cardiol. 2002 Dec;86(2-3):311-6 [PMID: 12419571]
  43. Crit Care Med. 2005 Oct;33(10 Suppl):S340-6 [PMID: 16215357]
  44. Trop Doct. 1995 Jul;25(3):118-23 [PMID: 7660481]
  45. N Engl J Med. 2001 May 24;344(21):1567-71 [PMID: 11372007]
  46. Obstet Gynecol. 1999 Aug;94(2):311-6 [PMID: 10432149]
  47. Cleve Clin J Med. 2009 May;76(5):289-96 [PMID: 19414544]
  48. Eur J Heart Fail. 2010 Aug;12(8):767-78 [PMID: 20675664]
  49. Cell. 2007 Feb 9;128(3):589-600 [PMID: 17289576]
  50. Cochrane Database Syst Rev. 2010 Sep 08;(9):CD008589 [PMID: 20824881]
  51. Am J Cardiol. 2006 Jun 15;97(12):1765-8 [PMID: 16765131]
  52. Int J Cardiol. 2011 Mar 3;147(2):202-8 [PMID: 19751951]
  53. Clin Rev Allergy Immunol. 2002 Dec;23(3):301-24 [PMID: 12402414]
  54. JAMA. 2000 Mar 1;283(9):1183-8 [PMID: 10703781]
  55. Can J Cardiol. 2006 Jan;22(1):23-45 [PMID: 16450016]

Word Cloud

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