Peripartum cardiomyopathy: an ominous complication of pregnancy

PPCM is a relatively rare and lethal disease, poorly characterized and about which little is known. A diagnosis is made within a confined narrow period, the ninth month of pregnancy to the fifth month postpartum. The signs and symptoms of heart failure are classic, and failure is confirmed by an echocardiogram primarily showing either hypertrophy or dilatation and a low ejection fraction. Other causes of heart failure should be ruled out before the diagnosis of PPCM is made. Treatment is supportive and similar to standard therapy for heart failure. Probabilities of atrial or ventricular emboli are similar to the other dilated cardiomyopathies in heart failure and are treated accordingly, i.e., with coumadin or enoxaparin. Since mortality rates are high and can be between 18% and 56%, heart transplantation has been performed and prognosis improved. Finally, immunosuppressant therapy has been used successfully in only a small number of patients who were unimproved after 2 weeks of standard therapy.