Peripartum Cardiomyopathy
Amanda S. Farrell, Jeffrey A. Kuller, S. Goldstein, Sarah K. Dotters‐Katz
Abstract
Importance Peripartum cardiomyopathy is a rare form of heart failure due to left ventricular systolic dysfunction that affects women late in pregnancy and the postpartum period. A diagnosis of exclusion, peripartum cardiomyopathy can be difficult to diagnose in the context of the normal physiologic changes of pregnancy and requires a high index of suspicion. Evidence Acquisition Original research articles, review articles, and guidelines on peripartum cardiomyopathy were reviewed. Results The etiology of peripartum cardiomyopathy remains poorly defined, but theories include genetic predisposition, as well as myocardial inflammation and angiogenic dysregulation. Risk factors for this condition include hypertensive disorders of pregnancy, Black race, and maternal age older than 30 years. Patients with peripartum cardiomyopathy are at increased risk of acute clinical decompensation, cardiac arrhythmias, thromboembolic complications, and death. Primary treatment modalities include initiation of a medication regimen aimed at the optimization of preload and reduction of afterload. Maternal clinical status is the primary determinant for timing of delivery. Conclusions and Relevance Prompt diagnosis and medical management by an interdisciplinary care team are vital for improving outcomes in patients with peripartum cardiomyopathy. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives After participating in this activity, the provider should be better able to describe the incidence, proposed etiologies, and risk factors for peripartum cardiomyopathy; outline diagnostic tools and evidence-based clinical management of peripartum cardiomyopathy; and identify the disparities in outcomes and existing knowledge gaps.