Journal of Preventive Cardiology
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Review Article

Year: 2019 I  Volume: 7I  Issue:4I  Pages: 1246 –1291
 

Peripartum Cardiomyopathy

Asha Moorthy, MD, DM, FCCP, FICP, FIACM, FIMSA, FICC1; Jain T. Kallarakkal, MD, FRCP, DM2

1Senior consultant Cardiologist, SRM Institutes for Medical Science, Nungambakkam, Chennai 600034
2Senior Interventional Cardiologist, St Mary’s Hospital, Thodupuzha, Kerala

 

Abstract

Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy presenting with heart failure secondary to left ventricular systolic dysfunction following delivery, where no other cause is found. Thus, it is a diagnosis of exclusion. Ejection fraction may decrease to nearly 45%. The incidence of PPCM is 0.46 per 1000 deliveries (0.18 for apparent PPCM and 0.28 for other cardiomyopathies, and higher incidence has been reported in AfricanAmerican women). The 16-kDa prolactin leads to increased microRNA 146a expression in endothelial cells, which exerts angiostatic effects and impairs the metabolic activity of cardiomyocytes. PPCM is more likely to occur in women aged > 30 years with history of pregnancy associated with hypertension and women with multifetal pregnancies. Bromocriptine has become standard therapy for PPCM. However, only approximately 50% patients with PPCM recover to baseline ventricular function within 6 months of delivery. Therefore, PPCM is a potentially life-threating cardiac disease that appears during the peripartum period. Although few patients recover cardiac function, long-lasting morbidity and mortality are common. Subsequent pregnancies in such patients are associated with a very high mortality rate and thus should be avoided. Women with PPCM continue to have significant mortality despite the use of conventional drugs for managing heart failure.

 
Keywords
Peripartum cardiomyopathy
Ejection fraction
Bromocriptine
Ventricular function
 
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Journal of Preventive Cardiology
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Print ISSN: 2249-4308
Online ISSN: 2277-6559
 
Frequency: Quarterly
 
 
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