Key result
Peripartum cardiomyopathy presents as rare pregnancy-associated systolic heart failure requiring standard heart failure management.
This review summarizes the epidemiology, risk factors, etiology, and management of peripartum cardiomyopathy, highlighting the avoidance of ACE inhibitors and ARBs during pregnancy.
Advises avoiding ACE inhibitors and ARBs in peripartum cardiomyopathy during pregnancy; leaves open need for dedicated prospective trials.
Peripartum cardiomyopathy (PPCM) is a rare and potentially fatal form of systolic heart failure which presents in later months of pregnancy and post-partum. Incidence varies over geography and ethnicity. It is highest in the African tribes of Hausa and Fulani. The incidence in the United States ranges from 1 in 1500-7500 births. Risk factors include advanced maternal age, multiparity, preeclampsia, multifetal gestation and African descent. Various etiologies such as viral myocarditis, abnormal immune and hemodynamic response to pregnancy, inflammatory mediation and genetic susceptibility have been proposed. Of late, the role of abnormal prolactin metabolism and resulting myocardial toxicity have been explored and bromocriptine has shown promise as a potential treatment option. Medical management is similar to other causes of systolic heart failure, except that ACE inhibitors and angiotensin receptor blockers are avoided in pregnancy. Complications include cardiac arrhythmias, thromboembolism and refractory heart failure can occur. Maternal deaths are not uncommon.
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Sharma et al. (2017) conducted a review in Peripartum cardiomyopathy. Peripartum cardiomyopathy is a rare and potentially fatal form of systolic heart failure presenting in late pregnancy or postpartum, with management similar to other causes of systolic heart failure.
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