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Cardiomyopathy, Peripartum

Cardiomyopathy, Peripartum is a topic covered in the 5-Minute Emergency Consult.

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  • Dilated cardiomyopathy occurring during the last month of pregnancy up to 5 mo following the delivery
  • Diagnostic criteria (all required):
    • Onset of myocardial failure during last month of pregnancy or 1st 5 mo after delivery
    • Absence of a specific cause
    • Absence of prior cardiac disease
  • Diagnosis requires strict criteria of echocardiographic dysfunction
  • Incidence: 3–5/10,000 live births
  • ∼50% of cases resolve spontaneously
  • Mortality: 18–56%
  • Risk factors:
    • Older women (>30 yr)
    • Multiparous women
    • Multiple gestations
    • Prolonged tocolytic therapy (>4 wk)
    • Obesity
    • 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


Various causes are suggested but remain unproved:
  • Viral infection leading to myocarditis in presence of immunosuppression during pregnancy (most likely)
  • Immunologic response to an unknown maternal or fetal antigen
  • Maladaptive response to the hemodynamic stresses of pregnancy
  • Stress-activated cytokines
  • Prolonged tocolysis
  • Selenium deficiency

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Rosen, Peter, et al., editors. "Cardiomyopathy, Peripartum." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307525/all/Cardiomyopathy__Peripartum.
Cardiomyopathy, Peripartum. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307525/all/Cardiomyopathy__Peripartum. Accessed April 20, 2019.
Cardiomyopathy, Peripartum. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307525/all/Cardiomyopathy__Peripartum
Cardiomyopathy, Peripartum [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 20]. 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
TY - ELEC T1 - Cardiomyopathy, Peripartum ID - 307525 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, 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 - 5 DB - Emergency Central DP - Unbound Medicine ER -