Women who develop postpartum cardiomyopathy experience the onset of heart failure either during the last month of pregnancy, or within five months of delivering a baby. These women have no prior underlying heart disease, and no other identifiable reason to develop heart disease. Their heart failure can be a temporary, self-limited condition, or can progress to severe, life-threatening heart failure.
What Causes Postpartum Cardiomyopathy?The cause of postpartum cardiomyopathy is not known. There is evidence that inflammation of the heart muscle (also called myocarditis) may play an important role, and may be related to inflammatory proteins that sometimes can be found in the blood during pregnancy. There is also evidence that fetal cells that occasionally escape into the mother's bloodstream can cause an immune reaction, leading to myocarditis. Furthermore, there may be a genetic predisposition to postpartum cardiomyopathy in some families.
Who Gets Postpartum Cardiomyopathy?While postpartum cardiomyopathy is thankfully a rare condition (occurring in about 1 of 4,000 deliveries in the U.S.), some women seem to be at higher risk than others. Risk factors for postpartum cardiomyopathy include: age over 30 years, having delivered children before, pregnancy with multiple fetuses, African descent, a history of preeclampsia or postpartum hypertension, and cocaine abuse.
What Are The Symptoms of Postpartum Cardiomyopathy?Since postpartum cardiomyopathy leads to heart failure, the symptoms are essentially the same as for most other forms of heart failure.
How is Postpartum Cardiomyopathy Treated?With a few notable exceptions, postpartum cardiomyopathy is treated similarly to any form of dilated cardiomyopathy.
The notable exceptions to "standard" heart failure treatment come into play when the heart failure occurs before the baby is delivered. Some of the "routine" treatments for heart failure should be withheld until delivery.
Specifically, ACE inhibitors such as Vasotec (enalapril), which are drugs that dilate blood vessels, should not be used during pregnancy, since these drugs can adversely affect the fetus. Instead, hydralazine can be substituted as a blood vessel dilator until delivery has occurred. Similarly, the drugs spironolactone and Inspra (eplerenone) -- the so-called aldosterone antagonists, which can be helpful in treating some patients with dilated cardiomyopathy -- have not been tested during pregnancy, and should be avoided.
A Final NoteIt is especially important to know that women who have had postpartum cardiomyopathy -- even the women who seem to have made a complete recovery -- are at particularly high risk of developing the condition again with subsequent pregnancies. And if postpartum cardiomyopathy occurs for a second time, the risk of more permanent and severe cardiac damage becomes very high.
So once a woman has had postpartum cardiomyopathy, she should avoid becoming pregnant again.
Sliwa K, Fett J, Elkayam U. Peripartum cardiomyopathy. Lancet 2006; 368:687.
Pearson GD, Veille JC, Rahimtoola S, et al. Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review. JAMA 2000; 283:1183.