Peripartum Cardiomyopathy (PPCM) is rare form of cardiomyopathy of unknown etiology occurring in late pregnancy or postpartum period. PPCM is assosciated with significant morbidity and mortality in peripartum period. As ACE inhibitors are contraindicated during pregnancy, diuretics and betablockers are main stay of treatment. In postpartum period, PPCM is treated as per guideline directed therapy for heart failure. In many patients with PPCM, LVEF improves after postpartum period but in those, whose LVEF remains depressed has high tendency for recurrence in subsequent pregnancies with increasing mortality. Most common arrhythmias occurring with PPCM are tachyarrythmias and main stay of treatment are beta blockers. Many newer therapies including bromocriptine, pentoxifylline and immunoglobulin are being tried to treat PPCM. Device therapy is seldom required in PPCM and even if recommended, should be waited for atleast 3 to 6 month after diagnosis.
Keywords: Peripartum, Cardiomyopathy, pregnancy, heart failure
Hull E, Hafkesbring E. "Toxic" postpartal heart disease. New Orleans Med Surg J 1937; 89:550.
Sliwa K, HilfikerKleiner D, Petrie MC, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail 2010; 12:767.
Elkayam U, Akhter MW, Singh H, et al. Pregnancyassociated cardiomyopathy: clinical characteristics and a comparison between early and late presentation. Circulation 2005; 111:2050.
Pearson GD, Veille JC, Rahimtoola S, Hsia J, Oakley CM, Hosenpud JD, Ansari A, Baughman KL. Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review. JAMA. 2000;283:1183–1188.
Pandit V, Shetty S, Kumar A et al; Incidence and out come of peripartum Cardiomyopathy from a tertiary hospitalin South India. Trop Doct 2009;39:168-9.
Amos AM, Jaber WA, Russell SD. Improved outcomes in peripartum cardiomyopathy with contemporary. Am Heart J 2006; 152:509.
Kothari SS. Aetiopathogenesis of peripartum cardiomyopathy: prolactinselenium Interaction Int J Cardiol 1997; 60:111
Fett JD, Ansari AA, Sundstrom JB, Combs GF. Peripartum cardiomyopathy: a selenium disconnection and an autoimmune connection. Int J Cardiol 2002; 86:311.
Peripartum Cardiomyopathy Michael M. Givertz, MD Circulation.2013; 127: e622-e626doi: 10.1161/CIRCULATIONAHA.113.001851
Sliwa K, Förster O, Libhaber E, et al. Peripartum cardiomyopathy: inflammatory markers as predictors of outcome in 100 prospectively studied patients. Eur Heart J 2006; 27:441.
Hameed AB, Chan K, Ghamsary M, Elkayam U. Longitudinal changes in the Btype natriuretic peptide levels in normal pregnancy and postpartum. Clin Cardiol 2009; 32:E60.
Baruteau AE, Leurent G, Martins RP, et al. Peripartum cardiomyopathy in the era of cardiac magnetic resonance imaging: first results and perspectives. Int J Cardiol 2010; 144:143.
Alwan S, Polifka JE, Friedman JM. Angiotensin II receptor antagonist treatment during pregnancy. Birth Defects Res A Clin Mol Teratol 2005; 73:123.
Lavoratti G, Seracini D, Fiorini P, et al. Neonatal anuria by ACE inhibitors during pregnancy. Nephron 1997; 76:235.
Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in women of childbearing age: risks versus benefits. Pucci M1, Sarween N, Knox E, Lipkin G, Martin U.
Easterling TR, Carr DB, Brateng D, et al. Treatment of hypertension in pregnancy: effect of atenolol on maternal disease, preterm delivery, and fetal growth. Obstet Gynecol 2001; 98:427.
Bayliss H, Churchill D, Beevers M, Beevers DG. Antihypertensive drugs in pregnancy and fetal growth: evidence for "pharmacological programming" in the first trimester? Hypertens Pregnancy 2002; 21:161.
Lydakis C, Lip GY, Beevers M, Beevers DG. Atenolol and fetal growth in pregnancies complicated by hypertension. Am J Hypertens 1999; 12:541.
http://toxnet.nlm.nih.gov/cgibin/ sis/htmlgen?LACTMED (Accessed on July 01, 2014).
Beardmore KS, Morris JM, Gallery ED. Excretion of antihypertensive medication into human breast milk: a systematic review. Hypertens Pregnancy 2002; 21:85.
European Society of Gynecology (ESG), Association for European Paediatric Cardiology (AEPC), German Society for Gender Medicine (DGesGM), et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J 2011; 32:3147.
ESC Guidelines on the management of cardiovascular diseases during pregnancy The Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC) European Heart Journal (2011) 32, 3147–3197 doi:10.1093/eurheartj/ehr218
Rasmusson K, Brunisholz K, Budge D, et al. Peripartum cardiomyopathy: posttransplant outcomes from the United Network for Organ Sharing Database. J Heart Lung Transplant 2012; 31:180.
LoyagaRendon RY, Pamboukian SV, Tallaj JA, et al. Outcomes of patients with peripartum cardiomyopathy who received mechanical circulatory support. Data from the Interagency Registry for Mechanically Assisted Circulatory Support. Circ Heart Fail 2014; 7:300.
Pillarisetti J, Kondur A, Alani A, et al. Peripartum cardiomyopathy: predictors of recovery and current state of implantable cardioverterdefibrillator use. J Am Coll Cardiol 2014; 63:2831.
Sliwa K, Skudicky D, Bergemann A, et al. Peripartum cardiomyopathy: analysis of clinical outcome, left ventricular function, plasma levels of cytokines and Fas/APO1. J Am Coll Cardiol 2000; 35:701.
Cooper LT, Mather PJ, Alexis JD, et al. Myocardial recovery in peripartum cardiomyopathy: prospective comparison with recent onset cardiomyopathy in men and nonperipartum women. J Card Fail 2012; 18:28.
Sliwa K, Blauwet L, Tibazarwa K, et al. Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: a proofofconcept pilot study. Circulation 2010; 121:1465.
Fett JD, Sanon H, Carraway RD, Markham DW, Ernst S. Abstract 189: Pentoxifylline treatment for peripartum cardiomyopathy? J Cardiac Fail 2013; 19: S65-S66 [DOI: 10.1016/ j.cardfail.2013.06.213]
de Beus E, van Mook WN, Ramsay G, Stappers JL, van der Putten HW. Peripartum cardiomyopathy: a condition intensivists should be aware of. Intensive Care Med 2003;29:167–174.
Tomlinson M., Cardiac Diseases. In: James DK, Steer PJ, Weiner CP et al., eds. High Risk Pregnancy. Management Options. 3rd edn. Philadelphia: Elsevier Saunders; 2006. p798–827.
Haghikia A, Podewski E, Libhaber E, et al. Phenotyping and outcome on contemporary management in a German cohort of patients with peripartum cardiomyopathy. Basic Res Cardiol 2013; 108:366.
Murali S, Baldisseri MR. Peripartum cardiomyopathy. Crit Care Med 2005; 33:S340
Kao DP, Hsich E, Lindenfeld J. Characteristics, adverse events, and racial differences among delivering mothers with peripartum cardiomyopathy. JACC Heart Fail 2013; 1:409
McNamara D, Damp J, Elkayam U, Hsich E, Ewald G, Cooper L, Modi K, Ramani G, Alexis J, Semigran M, Drazner M, Haythe J, Pisarcik J, Marek J, Gorcsan J, Fett J. Abstract 12898: Myocardial recovery at six months in peripartum cardiomyopathy: Results of the NHLBI multicenter IPAC study (Circulation 2013, Supplement). Issue 22, Nov 26
Fett JD, Sannon H, Thélisma E, et al. Recovery from severe heart failure following peripartum cardiomyopathy. Int J Gynaecol Obstet 2009; 104:125.
HilfikerKleiner D, Haghikia A, Nonhoff J, Bauersachs J. Peripartum cardiomyopathy: current management and future perspectives. Eur Heart J 2015; 36:1090
Peripartum cardiomyopathy: A puzzle closer to solution James D Fett, Investigations of Pregnancy Associated Cardiomyopathy (IPAC), Peripartum Cardiomyopathy Network of North America (PCN), Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, United States James D Fett, Department of Adult Medicine, Hospital Albert Schweitzer, Deschapelles, Haiti World J Cardiol 2014 March 26; 6(3): 87-99.
How to Cite
Copyright (c) 2022 Anant Agrawal, Sanket Saraiya
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The contents of PUJHSR are protected under Indian and international copyrights. However, the journal contents are free for non-commercial purpose under the Creative Commons Attribution-Noncommercial-Share Alike 4.0 Unported License (https://creativecommons.org/licenses/by-nc-sa/4.0/).