Peripartum and post partum cardiomyopathy

Question 1

clinical features of peripartum cardiomyopathy

Answer 1

onset of heart failure during last month of pregnancy or within 5 months after delivery,
LV systolic dysfunction within LV EF <45%
absence of other causes of heart failure
absence of heart failure prior to final month of pregnancy

Question 2

what causes peripartum cardiomyopathy

Answer 2

likely multifactorial with immune mediated, myocarditis,

Question 3

risk factor for peripartum cardiomyopathy

Answer 3

age>30, 
multiparity,
 African descent, pregnancy with multiple fetuses,
 maternal cocaine use, 
beta agonist (terbutaline) use >4 weeks.

Question 4

how to treat peripartum cardiomyopathy

Answer 4

treat as usual HF therapy but no ACEi or ARBs should be taken with pregnancy

loop diuretics help relieve pulm congestion. Less bleeding risk with loop than thiazides for fetal bleeding

Question 5

Beta selective blockers are preferred in peripartum cardiomyopathy because of

Answer 5

decreased risk of uterine relaxation nad peripheral vasodilation

Question 6

can we use digoxin in pregnant women?

Answer 6

yes only considered in pts with peripartum cardiomyopathy who fail 1st line therapies

Question 7

Major predictor of persistent LV dysfunction after peripartum cardiomyopathy

Answer 7

If LVEFis <30 at the time of diagnosis.

Question 8

pts who recover LV function in peripartum cardiomyopathy

Answer 8

have lower risk for complications during subsequent pregnancies but will still have elevated risk compared to normal population.

Question 9

pts who have persistent LV dysfunction going into pregnancy

Answer 9

have higher risk for complications- significant decline in LVEF and recurrent heart failure and death and so should avoid subsequent pregnancies.

Question 10

risk factors for peripartum cardiomyopathy:

Answer 10

multiparity
advanced maternal age >30 years
multifetal pregnancy
pre-eclampsia
gestational hypertension
African American ethnicity