Postpartum Cardiomyopathy

Cardiomyopathy is a term used to describe damage to the heart that results in a weakened heart. The weakened heart muscle makes it difficult for the heart to pump blood efficiently and results in decreased heart function.

This in turn affects the lungs, liver and other parts of the body.

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Peripartum cardiomyopathy is a rare type of cardiomyopathy that affects pregnant women during their last month of pregnancy or within 5 months of delivery. Postpartum cardiomyopathy is the term used to describe peripartum cardiomyopathy that occurs after the delivery of the child.

In the United States, the incidence of postpartum cardiomyopathy ranges from 1 in every 1,300 deliveries to 1 in every 4,000 deliveries. It can affect women of any age but usually occurs in older women after the age of 30. Women with a history of cardiac diseases such as myocarditis are at a higher risk of developing postpartum cardiomyopathy. Other risk factors for developing this disorder include obesity, smoking, heavy drinking, the use of certain medications, multiple pregnancies and malnourishment.

Symptoms of Postpartum Cardiomyopathy

According to the New York Heart Association, postpartum cardiomyopathy can be classified into 4 categories depending on the severity of the symptoms exhibited.

  • Class I – This is characterized by the absence of any symptoms
  • Class II – Mild symptoms are evident during periods of extreme exertion
  • Class III – Symptoms are evident with minimal exertion
  • Class IV – Symptoms are evident while resting

Typical symptoms of postpartum cardiomyopathy include:

  • Fatigue
  • Shortness of breath during periods of activity or even at rest
  • Racing or irregular pulse and palpitations
  • Frequent urination during the night
  • Swelling of the ankles

A physical examination by a doctor may reveal additional signs and symptoms such as:

  • Fluid buildup in the lungs
  • A rapid heart rate
  • Abnormal crackling sounds from the lungs
  • Abnormal sounds from the heart
  • Enlarged liver
  • Swollen neck
  • Lowered blood pressure when the patient stands up

Tests such as chest x-rays, chest CT scans, coronary angiography, echocardiogram and nuclear heart scan may reveal additional symptoms. These include:

  • An enlarged heart
  • Congestion in the lungs or the veins in the lungs
  • A decreased cardiac output
  • Decreased heart function
  • Signs of heart failure

One test in particular is helpful in diagnosing the underlying cause of postpartum cardiomyopathy. This is a heart biopsy. It can help in diagnosing myocarditis, a common cause of postpartum cardiomyopathy.

Causes of Postpartum Cardiomyopathy

The exact causes of postpartum cardiomyopathy remain a mystery. Recent data shows a higher incidence of myocarditis in women with postpartum cardiomyopathy leading researchers to suspect the former as a cause. However, this conclusion is still the matter of debate.

Many medical professionals suspect that nutritional disorders can cause postpartum cardiomyopathy. However, excessive intake of salt is the only one that has been shown to increase the risk of developing this disorder.

Lower levels of the element Selenium have also been associated with postpartum cardiomyopathy.

Some studies have shown that auto-antibodies against myocardial proteins may also play a role in the development of this disorder. Preeclampsia is thought to be another cause of postpartum cardiomyopathy.

There have been reports of women from the same family developing postpartum cardiomyopathy, leading medical professionals to suspect that genetics and family history can be a cause of developing this disorder.

Treatment for Postpartum Cardiomyopathy

Treatment options for postpartum cardiomyopathy include:

  • Hospitalization and complete bed rest until the cessation of acute symptoms
  • Since heart dysfunction in most cases is usually reversible, symptoms are treated only if they are acute
  • Digitalis may be prescribed to increase the heart’s pumping ability
  • Diuretics may be prescribed to reduce fluid buildup in case of pulmonary edema
  • Anti-hypertensive medications such as beta blockers, vasodilators and calcium channel blockers may also be prescribed
  • Anticoagulants may be prescribed to prevent the occurrence of thromboembolic complications such as venous or arterial thrombosis
  • Anti-platelet agents such as pentoxifylline may also be prescribed

In most cases, these measures are usually sufficient. However in advanced cases of postpartum cardiomyopathy where the patient does not respond satisfactorily to these treatments, the physician may have to resort to extreme measures. These include:

  • Immunosuppressive therapy – These drugs are usually used to treat cancer patients or those who have undergone organ transplant.
  • Aortic counter-pulsation balloon – This is a balloon heart pump that is implanted surgically.

Other measures that are suggested to help speed recovery include:

  • A low salt diet or a no salt diet is essential to prevent excessive fluid buildup.
  • Nursing the baby may have to cease when symptoms develop.
  • Women who smoke and drink alcohol should stop completely as these activities will only serve to exacerbate the symptoms.
  • Body weight must be measured every day to detect signs of fluid buildup.

The prognosis for women with postpartum cardiomyopathy varies. Some women remain stable for long periods and their symptoms usually subside after some time. Others can get worse either gradually or rapidly. Those who undergo a rapid deterioration in their condition are usually candidates for a heart transplant and the mortality rate in such cases may be as high as 50%.

The prognosis for women whose heart rapidly returns to its normal size after delivery is good. A heart that remains enlarged after delivery makes future pregnancies risky as it increases the chances of heart failure.

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