Peripartum cardiomyopathy

Descripción general

Peripartum cardiomyopathy (kahr-dee-o-my-OP-uh-thee) is a disease of the heart muscle that happens during pregnancy or soon after delivery. Peripartum means the time around childbirth.

Usually, peripartum cardiomyopathy (PPCM) happens during late pregnancy or in the months right after the baby is born. Another name for the condition is pregnancy-associated cardiomyopathy. When it starts after delivery, it also may be called postpartum cardiomyopathy.

PPCM is not common. The exact number of people who develop it is not known. But it can be serious. In people with PPCM, the heart's main pumping chamber, called the left ventricle, gets weak. The heart can't squeeze hard enough to pump blood to the rest of the body. This can lead to heart failure.

It's thought that hormone changes that happen during pregnancy may play a role in peripartum cardiomyopathy. Some people have a gene change that makes them more likely to get the condition.

Treatment of peripartum cardiomyopathy depends on your symptoms and how well the heart pumps blood. If you are still pregnant, your care team also thinks about the health of your baby. Peripartum cardiomyopathy can get better with treatment. Medicines can help the heart pump better and ease symptoms. In many people with PPCM, the heart gets stronger over time. For others, the heart gets stronger but does not fully recover. But in some people, the heart stays very weak. In those people, a heart transplant may be needed.

Types

There are different types of cardiomyopathy. This article focuses on peripartum cardiomyopathy (PPCM).

PPCM is similar to dilated cardiomyopathy. But PPCM is considered a separate condition that happens during pregnancy or in the months after delivery.

Another type is hypertrophic cardiomyopathy. Some people may already have this type of cardiomyopathy before pregnancy or learn they have it during pregnancy.

Síntomas

Peripartum cardiomyopathy (PPCM) usually occurs during late pregnancy or the months after delivery. Some symptoms can seem like changes that naturally happen during pregnancy or after delivery. For example, you may feel very tired.

PPCM symptoms happen when the heart can't pump blood as it should. The condition causes symptoms of heart failure. Symptoms can include:

• Shortness of breath or trouble breathing with activity or even at rest.
• Trouble breathing when you lie flat.
• A cough while lying down.
• Feeling very tired, even after getting rest.
• Swelling in your legs, ankles or feet.
• Fast or pounding heartbeats.
• Fainting or feeling dizzy or lightheaded.
• Chest discomfort or pain, mostly after physical activity or heavy meals.

In some people, the symptoms get worse quickly.

When to seek care

Call your healthcare professional if you are pregnant or recently gave birth and have any of these symptoms:

• Shortness of breath that is new or getting worse.
• Chest discomfort.
• Fast or pounding heartbeats.
• Swelling that is new or getting worse.

When to seek emergency care

Peripartum cardiomyopathy (PPCM) can cause heart failure.

Call 911 or your local emergency number if you have symptoms such as:

• Severe weakness.
• Sudden, severe shortness of breath or very fast breathing.
• Chest pain that is not explained or lasts for more than a few minutes.
• Very fast or pounding heartbeats with shortness of breath, chest pain or fainting.
• Weak pulse.
• Low blood pressure.
• Urinating less than usual or not at all.

These symptoms may happen when the heart can't pump blood as it should. But there are many other possible causes. At the emergency room, healthcare professionals do tests to learn if your symptoms are due to heart failure or something else.

Causas

The exact cause of peripartum cardiomyopathy is not known. Researchers think several changes may work together to weaken the heart. These changes may include:

• Hormone changes. The body may break down a hormone called prolactin into a form that harms heart muscle and blood vessels. Prolactin is the hormone involved in making breast milk.
• Changes in blood vessels during pregnancy. The placenta grows during pregnancy to give the baby oxygen and nutrients. It also makes substances that may harm blood vessels. This may weaken the heart.
• Genetics. Some people with PPCM have changes in genes that are linked with another heart condition that weakens the heart muscle. That condition is called dilated cardiomyopathy. Researchers are still learning how genes and pregnancy work together to cause PPCM.

Factores de riesgo

Some things make you more likely to get peripartum cardiomyopathy. But having a risk factor does not mean that you will definitely develop PPCM. Some risk factors cannot be changed.

Risk factors for peripartum cardiomyopathy may include:

• Preeclampsia, a pregnancy complication that involves high blood pressure, high levels of protein in the urine and signs of organ damage.
• High blood pressure during pregnancy.
• Pregnancy with twins or other multiples.
• Being age 30 or older during pregnancy.
• Some gene changes, especially changes in a gene called TTN.
• Not having enough healthy red blood cells, called anemia.
• Race. PPCM is much more likely to develop in Black women than it is in white women.

Complicaciones

Peripartum cardiomyopathy can lead to serious health conditions, including:

• Heart failure. The heart can't pump enough blood to meet the body's needs. Without treatment, heart failure can be life-threatening. Some people may need a heart device to help the heart pump.
• Blood clots. Because the heart can't pump well, blood clots might form in the heart. If clots enter the bloodstream, they can block the blood flow to other organs, including the heart and brain.
• Cardiogenic shock. This is a life-threatening condition that happens when the heart can't pump enough blood to the body's organs.
• Heartbeats that are not regular. Peripartum cardiomyopathy can cause the heart to become larger. This can cause changes in the heartbeat, called arrhythmias.
• Sudden cardiac arrest and sudden cardiac death. Cardiomyopathy can trigger heartbeat changes that cause the heart to stop beating. This can lead to sudden cardiac death.

Prevención

If you are pregnant, go to all your pregnancy care visits. Tell your healthcare professional about any new symptoms or if any symptoms get worse. If you have had PPCM before, talk with your cardiologist and pregnancy care team before another pregnancy. PPCM can come back during a future pregnancy.