Cardiomyopathy, Peripartum
Basics
Description
Description
- Dilated cardiomyopathy occurring during the last month of pregnancy or up to 5 mo following delivery
- Diagnostic criteria (all required):
- Onset of myocardial failure during last month of pregnancy or first 5 mo after delivery
- Absence of a specific cause
- Absence of prior cardiac disease
- Diagnosis requires strict criteria of echocardiographic dysfunction: LVEF <45%
- Incidence: 3–5/10,000 live births
- Varies based on geographic location
- Mortality: 18–56%
- Risk factors:
- Older women (>30 yr)
- Multiparous women
- Multiple gestations
- Prolonged tocolytic therapy (>4 wk)
- Obesity
- Cocaine abuse
- Preeclampsia
- African American
- Systemic and pulmonary embolism more frequent than with other forms of cardiomyopathy
- Factors indicating a poor prognosis:
- Lower left ejection fraction at 6 mo postpartum
- Onset >2 wk postpartum
- Age >30 yr
- African American descent
- Multiparity
- 46–63% have LVEF recovery in 6 mo
Etiology
Various causes are suggested but remain unproved:Etiology
- Viral infection leading to myocarditis in presence of immunosuppression during pregnancy (most likely)
- Immunologic response to an unknown maternal or fetal antigen
- Abnormal prolactin processing
- Abnormal angiogenesis/vascular damage
- Maladaptive response to the hemodynamic stresses/LV remodeling of pregnancy
- Stress-activated/inflammatory cytokines
- Prolonged tocolysis
- Selenium deficiency
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Citation
Schaider, Jeffrey J., et al., editors. "Cardiomyopathy, Peripartum." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307525/all/Cardiomyopathy_Peripartum.
Cardiomyopathy, Peripartum. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307525/all/Cardiomyopathy_Peripartum. Accessed December 3, 2024.
Cardiomyopathy, Peripartum. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307525/all/Cardiomyopathy_Peripartum
Cardiomyopathy, Peripartum [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 03]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307525/all/Cardiomyopathy_Peripartum.
* Article titles in AMA citation format should be in sentence-case
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T1 - Cardiomyopathy, Peripartum
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ED - Shayne,Philip,
ED - Rosen,Peter,
ED - Schaider,Jeffrey J,
ED - Barkin,Roger M,
ED - Hayden,Stephen R,
ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307525/all/Cardiomyopathy_Peripartum
PB - Lippincott Williams & Wilkins
ET - 6
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