Peripartum Cardiomyopathy: Diagnostic and Therapeutic Challenge

Abstract

Emergencies during pregnancy represent particular challenges in medicine. During the course of pregnancy, the maternal organism undergoes numerous physiological changes. The present article aims to raise awareness of this issue. Peripartum cardiomyopathy is a rare type of heart failure that occurs in pregnant women in the last month of pregnancy or within first 5 months postpartum. An incidence of up to 1:15,000 has been reported, varying by geographic area. Clinical symptoms are consistent with idiopathic cardiomyopathy. Diagnosis is primarily based on echocardiography, which reveals a marked diminution in systolic left ventricular function. Its therapeutic approach is likewise guided by the recommendations of idiopathic cardiomyopathies. This ranges from pharmaceutical approaches and mechanical cardiac support systems to a necessary heart transplantation as the last resort. Prognosis depends essentially on recuperation of heart failure within the first 6 months postpartum. Lethality of this condition is reported as high as 50%. Peripartum, close collaboration among the disciplines of cardiology, cardiac surgery, neonatology, obstetrics, anesthesiology, and intensive care medicine is essential. Regardless of the sparsity of this condition, every intensivist should include peripartum cardiomyopathy in his or her differential diagnostic considerations when the corresponding findings occur to ensure adequate perioperative and intensive care management.