Peripartum cardiomyopathy: diagnosis and management

### Learning objectives In 2010, the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy (PPCM) defined PPCM as ‘an idiopathic cardiomyopathy presenting with heart failure secondary to left ventricular (LV) systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause of heart failure is found. It is a diagnosis of exclusion’1 (figure 1). It is important to appreciate that not all heart failure during pregnancy is due to PPCM. Other cardiovascular conditions can present during pregnancy; for example, pre-existing cardiomyopathies or previously undiagnosed congenital or valvular heart disease. Figure 1 European Society of Cardiology PPCM Working Group definition of peripartum cardiomyopathy. The incidence of PPCM varies between countries and between races within countries. In Africa, among predominantly black populations, the incidence is around 1 in 1000 live births.2 There are a few countries where PPCM appears to be much more common. For example, in Nigeria and Haiti, an incidence of 1 in 100 and 1 in 300 pregnancies respectively has been reported.3 4 In the USA, the incidence in predominantly white populations is between 1 in 1000 and 1 in 4000, but in African-American populations it is between 1 in 1000 and 1 in 2000.5–7 The incidence in Europe and Australasia is not well studied. The incidence does appear to be increasing—possibly due to increased awareness and diagnosis.8 It is striking that PPCM is often only recognised when patients are very sick with severe myocardial dysfunction. It seems likely that less severe forms of PPCM go undiagnosed, with symptoms being ascribed to the stresses around the arrival of a new child …