Typically, peripartum cardiomyopathy occurs in the first 4 months postpartum; fewer than 10% of cases occur prepartum. Common symptoms include dyspnea, cough, orthopnea, hemoptysis, and paroxysmal nocturnal dyspnea. Most affected patients have New York Heart Association (NYHA) class III or IV function. Additional symptoms include nonspecific fatigue, malaise, palpitations, chest and abdominal discomfort, and postural hypotension. Diagnosis requires a high degree of suspicion, because symptoms of peripartum cardiomyopathy can be confused with physiologic changes associated with advanced pregnancy.
Diagnostic Criteria for Peripartum Cardiomyopathy
1. Development of heart failure in last month of pregnancy or 5 months postpartum
2. Absence of preexisting heart disease
3. Indeterminant cause
4. Echocardiographic findings (a, together with b or c; or all of these)
- Left ventricular end-diastolic dimension >2.7 cm/m2
- M-mode fractional shortening <30%
- Left ventricular ejection fraction <0.45
References:
- Arany Z. Peripartum Cardiomyopathy. N Engl J Med. 2024 Jan 11;390(2):154-164. [Medline]
- Sawyer JM, Moridzadeh N, Bavolek RA. Cardiovascular Complications of Pregnancy. Emerg Med Clin North Am. 2023 May;41(2):247-258. [Medline]
- Bhattacharyya A, Basra SS, Sen P, Kar B. Peripartum cardiomyopathy: a review. Tex Heart Inst J. 2012;39(1):8-16. [Medline]
Created May 17, 2024.
