Peripartum cardiomyopathy. A review

The objective of this article is to review the aetiology, epidemiology, diagnosis, clinical course, treatment and prognosis of peripartum cardiomyopathy (PPCM). The medical literature from 1966 to March 2002 was reviewed through MEDLINE. PPCM is a rare complication in pregnancy. It is seen in late pregnancy or in the early puerperium. The aetiology of this disease remains uncertain. Many possible causes have been proposed, including myocarditis, abnormal immune response to pregnancy, maladaptive response to the hemodynamic stresses of pregnancy and prolonged tocolysis. Risk factors for PPCM include advanced maternal age, multiparity, African descent, twinning and long-term tocolysis. Patients with systolic dysfunction during pregnancy are treated the same as patients who are not pregnant. The mainstays of medical therapy are digoxin, loop diuretics, sodium restriction and afterload reducing agents (hydralazine and nitrates). Due to a high risk for venous and arterial thrombosis, anticoagulation with heparin should be instituted. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers should be avoided during pregnancy because of severe adverse neonatal effects. The utility of immunosuppressive therapy remains ambiguous. Advances in medical therapy for dilated cardiomyopathy and cardiac transplantation have significantly improved the quality of life and survival for patients.