Peripartum Cardiomyopathy

Posted by e-Medical PPT Friday, February 24, 2012
Peripartum cardiomyopathy is defined on the basis of four criteria:
  1-  Development of cardiac failure in the last month of
         pregnancy or within five months of delivery
  2-  Absence of an identifiable cause for the cardiac failure
  3-  Absence of recognizable heart disease prior to the last
          month of pregnancy
  4-  Left ventricular systolic dysfunction demonstrated by
          classic echocardiographic criteria, such as depressed
          shortening fraction or ejection fraction

The true incidence of PPCM is unknown; estimates proposed over the last several decades range from 1 per 1300 to 1 per 15,000 live births

Unknown etiology
No hormonal disorder has been identified in patients with PPCM, even though estrogen, progesterone, and prolactin have significant effects upon the cardiovascular system
Inflammatory cytokines may play a role in PPCM
                ( TNF, IL6, Fas receptor, ….)
Myocarditis , evidence by endomyocardial biopsies
A maternal immunologic response to a fetal antigen has been proposed as another potential etiology of PPCM
Familial or genetic etiology can not be excluded

Risk Factors
Age greater than 30 years
Multiparity
Women of African descent
Pregnancy with multiple fetuses
A history of preeclampsia, eclampsia, or postpartum hypertension
Association with maternal cocaine abuse or selenium deficiency
Long term (>4 weeks) oral tocolytic therapy with beta adrenergic
           agonists such as : Terbutaline.

Diagnosis   
The development of CHF signs and symptoms
EKG: sinus tachy, a-fib, low voltages , prolong PR/QRS, non specific ST-T wave changes
CXR: enlargement of the cardiac silhouette with evidence of pulmonary venous congestion and/or interstitial edema, pleural effusions.
The echocardiogram and Doppler usually reveal left ventricular enlargement with significant global reduction in overall performance without LVH 
The role of endomyocardial biopsy remains unclear.
Viral and bacterial cultures, as well as selected viral titers (eg, Coxsackie B) should also be considered...

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