Peripartum cardiomyopathy is a rare but serious complication of pregnancy. In this condition, the woman’s heart muscles become weak and enlarged in size during final months of pregnancy or within 5 to 6 months after delivery. In the United States, the incidence of peripartum cardiomyopathy is 1 in 3000 live births. The definite cause is not known but several risk factors have been suspected such as chronic high blood pressure, smoking, history of heart disease etc.
The symptoms of peripartum cardiomyopathy are similar to those of heart failure. The rate of recovery depends on the degree of severity of the condition. In some woman the recovery is complete while in others the heart function may remain compromised for long period. There is no targeted treatment yet available. Treatment includes use of ACE inhibitor medicine, beta blockers and diuretics to reduce blood pressure and excess load on heart.
Risk Factors Of Peripartum Cardiomyopathy
The exact underlying cause of peripartum cardiomyopathy is unclear. Actually the heart has to function more during pregnancy to meet the vital nutritional requirement and oxygen for the fetus. There are several plausible risk factors that have been suspected to trigger this condition. They are as follows:
- Nutritional deficiency
- Multiple pregnancies
- Diabetes during pregnancy
- Age over 30 years
- Chronic blood pressure or pregnancy induced hypertension.
- History of coronary artery spasm, small blood vessel disease.
- Hormonal abnormality may be contributing as many women with peripartum cardiomyopathy have been found to have low level of estrogen, progesterone and prolactin at the time of pregnancy.
- People of African American ethnicity are at greatest risk.
- Tocolytic used for long period. Tocolytics are medicines that are used to prevent premature labor.
Signs And Symptoms Of Peripartum Cardiomyopathy
The symptoms of peripartum cardiomyopathy are similar to heart failure. The symptoms usually appear in the later stage of pregnancy or 5 months after delivery. In majority of women the problem occurs after delivery. Here are important signs and symptoms that will help to diagnose the condition besides several other diagnostic procedures such as echocardiogram, ECG, clinical examination etc.
- Severe tiredness during physical activity.
- Breathlessness while walking or at rest.
- Swelling in ankle and face.
- Increased frequency of urination during nighttime.
- Rapid heartbeats (palpitation).
- Pain in chest.
Treatment For Peripartum Cardiomyopathy
For diagnosis of peripartum cardiomyopathy, the doctor will take into consideration several aspects such as physical examination, X-ray of chest, 2 D echocardiography.
Once the diagnosis is made, the woman has to stay in hospital until the symptoms are under control. The treatment will be according to the severity of the condition. The damage to the heart muscles is irreversible, but still the heart can function depending on the severity of damage. If the heart is severely damaged heart transplant may be necessary.
However, in at least half of cases the heart returns to its normal size after delivery. Treatment involves controlling the symptoms so that further damage is prevented. Certain medicines will help the patient to relieve of her symptoms. The medications given are beta blockers to reduce and stabilize blood pressure. Diuretic medicine will help to flush out excess of fluid from the body. Patient is recommended to reduce the intake of salt to manage blood pressure within normal limits. Patient must avoid smoking and alcohol. The residual cardiopathy may remain for life. Hence regular check up and medications is required for the patient.