Peripartum Cardiomyopathy
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Abstract
Peripartum Cardiomyopathy is defined as cardiomyopathy that develops in the last month of gestation or in the first 5 months in the postpartum period without any identifiable cause. Pathogenesis is poorly understood. However, infections, immunologic and nutritional causes have been implicated. Clinical presentation includes the usual signs and symptoms of heart failure. Diagnosis is based on clinical presentation of congestive heart failure and objective evidence of left ventricular systolic dysfunction. Early diagnosis and initiation of treatment are essential to optimize the outcome of the parturient. Medical management comprises sodium restriction, loop diuretics, afterload reducing agents (hydralazine, nitrates), and digoxin. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers should be avoided during pregnancy because of severe adverse neonatal effects and can be substituted for by hydralazine and nitrates during pregnancy. Some ACE inhibitors can be used in the postpartum period even in women who are breast feeding. Patients with persistent left ventricular abnormalities have a poor prognosis. If medical therapy fails, patients may then be treated with mechanical circulatory support devices and (or) cardiac transplantation.
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