Peripartum (Postpartum) Cardiomyopathy (PPCM)

• Dyspnea, dizziness, orthopnea, and decreased exercise capacity are common pregnancy symptoms.  
• The severity of symptoms in PPCM patients can be classified as follows: 
• Class I - A disease that has no symptoms 
• Class II - Mild symptoms/effect on function or symptoms only with extreme exertion  
• Class III - Class III - Symptoms with little effort -  
• Class IV - Symptoms at rest 
• New or sudden onset of the following symptoms necessitates immediate evaluation: Cough, orthopnea, PND, fatigue, palpitations, hemoptysis, chest pain, and abdominal pain. 

Book an appointment with your cardiologist if you experience any of these symptoms or call the emergency number right away if you experience any chest pain or discomfort. 

The root cause is unknown. In some cases, heart biopsies reveal that women have inflammation in the heart muscle. This could be due to a previous viral infection or an abnormal immune response. Poor nutrition, coronary artery spasm, small-vessel disease, and faulty antioxidant defenses are all possible causes. Genetics may also be involved. Among the risk factors are: 

• Older maternal age  
• History of cardiac disorders such as heart attack, heart valve dysfunction, or myocarditis (inflammation of the heart muscle)  
• Toxin exposure such as alcohol or chemotherapy 
• Having multiple pregnancies 
• Multifetal pregnancy (i.e., twins)  
• Premature labour medication use  
• African ancestry  
• Poor nutrition 

Women should avoid smoking and alcohol, eat a well-balanced diet, and exercise regularly to develop and maintain a strong heart.  

• ECG and rhythm monitoring 
• Imaging studies such as echocardiography, chest radiography, and magnetic resonance imaging 
• Cardiac catheterization and invasive hemodynamic monitoring 
• Stress testing  
• Tissue analysis and histologic findings  
• Cardiac biomarkers, to assess kidney, liver, and thyroid function; tests to assess electrolytes, including sodium and potassium; and a complete blood count to look for anemia or evidence of infection 

An echocardiogram can detect cardiomyopathy by demonstrating the heart's diminished function. 

Nonpharmacologic management: 

• A low-sodium (2 g sodium chloride per day) diet, with activity limited only by the patient's symptoms. 

Pharmacologic management: 

• Medical therapy: Digoxin, loop diuretics, and beta-adrenergic blocking with carvedilol or metoprolol succinate are all examples of medical treatment. To lower afterload, hydralazine and nitrates are employed. Anticoagulation options include warfarin, low-molecular-weight heparin (LMWH), and unfractionated heparin (UFH). 
• Device therapy, which includes left ventricular (LV) assist devices, intra-aortic balloon pumps, cardiac transplantation, and wearable cardioverter-defibrillators (WCD). 

Patients on hydralazine/nitrates should be switched to an ACEI after delivery, and the dose should be increased. Captopril and enalapril are thought to be lactation friendly.