II. Definitions
- Postpartum Cardiomyopathy
- Left Ventricular Systolic Dysfunction onset in late pregnancy or first 5 months postpartum
III. Epidemiology
- Incidence: 1:1000 to 4000 live births
- Onset
- Typical: First week after delivery (up to the first month)
- Range: Second trimester to 5 months postpartum
IV. Risk Factors
- Advanced maternal age
- Preeclampsia
- Hypertension
- History of Peripartum Cardiomyopathy with prior pregnancy
- Multiple Gestation
- Multigravida
- Black race
- Poverty
- Cocaine Abuse
- Prolonged exposure to Tocolytic medications >4 weeks
V. Findings
- See Congestive Heart Failure
- Dyspnea on exertion
- Paroxysmal Dyspnea on exertion
- Orthopnea
- Lower Extremity Edema
VI. Labs
- See Congestive Heart Failure
- Serum Chemistry Panel
- Brain Natriuretic Peptide
VII. Differential Diagnosis
- See Cardiomyopathy
- Preeclampsia
- Postpartum Cardiomyopathy is a diagnosis of exclusion when no other Cardiomyopathy cause is identified
VIII. Imaging
IX. Diagnostics
-
Electrocardiogram
- May be normal or only demonstrate Sinus Tachycardia
-
Echocardiogram
- First-line study
X. Management
- See Congestive Heart Failure
- Pregnancy precautions
- Avoid ACE Inhibitors and Angiotensin Receptor Blockers
- Exercise caution with Diuretics (risk of Hypotension and uterine hypoperfusion)
XI. Prognosis
- Mortality (longterm): 11-16%
- Most women recover from Postpartum Cardiomyopathy
- Some women may have persistently reduced ejection fraction
- Future pregnancy mortality approaches 25% if ejection fraction has not returned to normal
- Hilfiker-Kleiner (2017) Eur J Heart Fail 19(12): 1723-8 [PubMed]
XII. References
- Lively and Clare (2022) Crit Dec Emerg Med 36(5): 4-10
- Brieler (2017) Am Fam Physician 96(10):640-6 [PubMed]
- Sliwa (2010) Eur J Heart Fail 12(8): 767-8 [PubMed]