Peripartum Cardiomyopathy (PPCMP)

Peripartum cardiomyopathy is usually of dilated cardiomyopathy that has unknown cause and it typically presents between last month of pregnancy and up to five months postpartum. This dilated cardiomyopathy is defined as abnormal or diminished cardiac function. This occurs when the muscles of heart become weak and unable to pump the blood properly. This complication is rare, occurring in 1 out of 1500-3000 deliveries.

Though the cause of PPCMP is unknown, some risk factors are associated that are following:
Obesity
Personal history of heart disease
Some medication
Smoking
Alcohol
Multiple pregnancies
Malnourishment

Clinical features: Orthopnea (difficulty in breathing while lying down)
Dyspnea (difficulty in breathing while doing ordinary activity)
Palpitation (awareness of heart beating)
Unexplained coughing
Edema (swelling) on the legs
Weight gain in the last trimester
Coughing and swelling indicates the pulmonary edema that is congestion in pulmonary arteries. Pulmonary edema is due to heart failure that is because of inability to pump enough blood that leads to venous congestion and decreased venous return; eventually, liver failure.

There is dilatation of the heart so more blood comes into the heart but because of inability of heart to pump all the blood; that means some blood remains in the heart and there’s increase risk of thrombosis (clot formation) and eventually there’s risk of thromboembolism (free form of clot) of different vital organ.

Prognosis of PPCMP: If adequate treatment is given at appropriate time than survival rate is high. Treatment is composed of Diuretics, Beta blocker and angiotensin converting enzyme inhibitors. Diuretic helps to decrease fluid overload in body, hence decrease in swelling. Beta blockers and angiotensin converting enzyme inhibitors helps in improvement in circulation. In addition to improving circulation, beta blocker also help the heart to beat rhythmically and so decrease palpitation hence improves in cardiac out put.
Other modalities that can improve in symptoms are adequate rest, limited physical activity and treating any concomitant disorder, proper nutrition.
Before having next pregnancy, it is advised to consult with doctor to evaluate your health. As sometime because of consequences of PPCMP there’s high risk of mortality in having next pregnancy.



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