Peripartum Cardiomyopathy (PPCM)

What is peripartum cardiomyopathy?  
Cardiomyopathy means complication of heart muscle. Peripartum cardiomyopathy is basically heart complications that happen to women during or after child delivery. Also known as postpartum cardiomyopathy, is a rare form of heart failure that is likely to happen from the last month of pregnancy to up to five months after delivery. 

PPCM is a condition where the heart chambers enlarge and the muscle weakens. This causes a decrease in blood pumped from the heart and as a result the heart is no longer able to support the oxygen demands of body organs. PPCM could be caused due to  differences in diet, lifestyle, other medical conditions or genetics.

How is it detected? 
PPCM is hard to detect because most symptoms are common and include swelling in the feet and legs, and some shortness of breath. Fluid accumulation in the lungs is a major sign of PPCM. Diagnostic tests like echocardiogram (ECG) can detect the diminished heart function. 


Other symptoms of the condition include: 

  • A sudden weight gain of 2-3 kilograms or more over a day or two may is a potential warning
  • Unexplained coughing without fever
  • Fatigue
  • Feeling of heart racing or skipping beats (palpitations)
  • Increased night time urination (nocturia)
  • Shortness of breath with activity and when lying flat
  • Swelling of the ankles
  • Swollen neck veins
  • Low blood pressure, or it may drop when standing up.

What are the causes?  
The precise cause is unclear. Some researchers suspect abnormal immune response as a trigger. Other potential causes may include poor nutrition, coronary artery spasm, small-vessel disease, and defective antioxidant defences. Genetics may also play a role.

The incidence of PPCM can increase with,

  • Obesity
  • History of heat disorders
  • Use of certain medications
  • Smoking
  • Alcoholism
  • Multiple pregnancies
  • Poor nourishment

How can PPCM be treated?  
The objective of PPCM treatment is to keep extra fluid from collecting in the lungs and to help the heart recover as fully as possible. Many women recover normal heart function or stabilize on medicines. Some progress to severe heart failure requiring mechanical support or heart transplantation. Early detection is the best way to treat PPCM

Prevention

  • Don’t assume that gaining weight dramatically during pregnancy is okay. While weight gain during pregnancy is almost unavoidable, lookout for signs of drastic increase in swelling of hands, feet, and sudden weight gain.
  • Eat a well-balanced diet and get regular exercise to help keep your heart strong.
  • Avoid cigarettes and alcohol.
  • Your doctor may advise you to avoid getting pregnant again if you have had heart failure during a previous pregnancy.
  • Check for family history of PPCM by talking to your immediate relatives to check if anyone in the family had ever symptoms of heart disease after delivery.

Control and manage salt diet, fluid restrictions, or daily weighing. (myocarditis).

How can women minimize their risk? 
To develop and maintain a strong heart, women should avoid cigarettes and alcohol, eat a well-balanced diet and get regular exercise. Women who develop peripartum cardiomyopathy are at high risk of developing the same condition with future pregnancies. 

What’s next?  
There is no clear therapy to effectively treat PPCM. Investigations are underway to understand the cause of PPCM and to develop new treatments. Treatments that alter the immune system have been tried but are not proven. Investigators also have focused on the role of prolactin in PPCM. Prolactin is a hormone released from the pituitary gland late in pregnancy and after delivery that stimulates breast milk production. Prolactin, however, may have adverse effects on the heart muscle by limiting its blood supply and causing cell death. Bromocryptine is a medication that inhibits the pituitary secretion of prolactin. Early studies suggest it helps treat PPCM, but more research is needed.