Pregnancy-associated cardiomyopathies

Cardiovascular disease is a major cause of complications in pregnancy worldwide and the number of patients who develop cardiac problems during pregnancy is increasing.The physiological changes occurring during pregnancy and in the peripartum period provide a challenge to the cardiovascular system of all women.Understanding the morphological and functional changes in normal pregnancy is therefore important for the timely recognition of cardiovascular pathology during this vulnerable period.However, evidence-based clinical data in this field are scarce and there is a deficit in understanding general physiological and pathophysiological processes operating in the maternal heart around pregnancy.This review focuses on novel aspects of physiological and pathophysiological changes of the maternal cardiovascular system with a special focus laid on hypertensive complications in pregnancy, i.e., pre-eclampsia.A second focus is set on peripartum heart failure, especially peripartum cardiomyopathy (PPCM) which is a potentially life-threatening heart disease emerging towards the end of pregnancy or in the first postpartal months i n previously healthy women.W e present clinical and basic science data on the current state of knowledge of normal pregnancy, pre-eclampsia and PPCM and bring them into context thereby highlighting promising novel diagnostic tools and therapeutic approaches.