Peripartum cardiomyopathy is a rare form of heart failure that can happen between the last month of pregnancy and up to five months after childbirth.
It may be difficult to diagnose because characteristic swelling and shortness of breath resemble common third-trimester pregnancy symptoms – it’s uncertain how many cases occur in the United States, but the incidence is likely somewhere between 1 in 1,000 to 1 in 4,000 live births.
One interesting thing about peripartum cardiomyopathy is that there is definite geographic variation in incidence of this disease around the world, with some countries, such as Nigeria having high rates (1 in 100) and other countries, such as Japan, having very low rates (1 in 20,000). Some explanation for this variation may be differences in how the condition is diagnosed in different countries as well as certain genetic predispositions and cultural practices that may increase risk for development.
What Causes Peripartum Cardiomyopathy?
Researchers have been unable to define a clear cause of peripartum cardiomyopathy, but it results in an enlarged and weak heart with symptoms of heart failure
Symptoms of Peripartum Cardiomyopathy
Peripartum cardiomyopathy typically occurs between 36 weeks gestation and five months after delivery, but most often occurs within one month of giving birth. Symptoms of peripartum cardiomyopathy can overlap with normal symptoms of pregnancy, so it is important that you are getting regular checks with your obstetrician. If they are concerned, they will work closely with your Women’s Heart Health cardiologist to make sure you are being evaluated and treated appropriately. Some of the common symptoms include:
- Shortness of breath
- Rapid heartbeat or Palpitations
- Fatigue, especially during physical activity
- Swelling in legs, feet and ankles
- Weight gain
- Bloating, abdominal pain
- High blood pressure
- Increased urination at night
- Difficulty lying flat
- Waking up at night short of breath
Risk Factors of Peripartum Cardiomyopathy
These factors can increase your chances of developing peripartum cardiomyopathy:
- Maternal age over 30
- African descent
- Pregnancy with multiple fetuses
- High blood pressure, particularly preeclampsia and eclampsia
- Diabetes
- Use of some medications that prevent premature delivery
Diagnosing Peripartum Cardiomyopathy
Your Women’s Heart Wellness cardiologist, as part of a physical exam, following a review of your symptoms, will use a stethoscope to look for signs of fluid in your lungs, a rapid heart rate or other unusual heart sounds.
Additional tests might include:
Your cardiologist will assess your heart’s ability to pump blood with an echocardiogram. If the pumping efficiency has diminished (ejection fraction less than 45 percent) and there is no other explanation for the reduction, a diagnosis is made. The ejection fraction (EF) assesses the amount of blood pumped by the left ventricle with each contraction. A normal EF is between 55 and 70 percent.
The incidence of peripartum cardiomyopathy is rising in the United States. We don’t know if this is because of improved diagnosis or because women today tend to have more risk factors for developing it such as increased maternal age and additional cardiovascular risk factors
Treating Peripartum Cardiomyopathy
Typically, patients with peripartum cardiomyopathy are treated similarly to other patients with heart failure. A combination of medication and, lifestyle changes can help control your symptoms.
Medications often include:
- Beta blockers: Help the heart beat slower, reducing blood pressure and enhancing blood flow by blocking adrenaline.
- ACE (angiotensin converting enzyme) inhibitors: Prevents the production of angiotensin II, which narrows your blood vessels.
- Digitalis: improves your heart’s pumping action.
- Diuretics: These drugs reduce fluid retention by filtering excess water and salt from your body.
- Anticoagulation: blood thinning medication that may be prescribed based on your heart’s pumping function to prevent clots from forming.
Prognosis
Most women have partial to complete recovery of their heart pumping function. Even with complete recovery, there can be recurrence of the cardiomyopathy, especially with subsequent pregnancies. Therefore, it is important to continue with routine follow-up with your Women’s Heart Wellness cardiologist and to get counseling prior to any future pregnancies.