Peripartum Cardiomyopathy

Peripartum Cardiomyopathy is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

Definition

  • PPCM is defined as LV systolic dysfunction diagnosed in the last month of pregnancy up to 5 months postpartum.
  • The incidence of PPCM is 1 in 1000–4000 pregnancies in the United States.1

Etiology

  • The etiology of PPCM remains unclear. There is evidence to support viral triggers, including coxsackievirus, parvovirus B19, adenovirus, and herpesvirus, which 
may replicate unchecked in the reduced immunologic state brought on by pregnancy.2,3
  • Fetal microchimerism, wherein fetal cells escape into the maternal circulation and induce an autoimmune myocarditis, has also been suggested as a cause.4
  • A cleavage product of prolactin has been implicated in the development of PPCM.5 Other vasculo-hormonal pathways have also been suggested to post a toxic challenge to the heart and lead to PPCM.1

Risk Factors

Risk factors that predispose a woman to PPCM include advanced maternal age, multiparity, multiple pregnancies, preeclampsia, and gestational hypertension. There is a higher risk in African American women, but this may be confounded by the higher prevalence of hypertension in this population.

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General Principles

Definition

  • PPCM is defined as LV systolic dysfunction diagnosed in the last month of pregnancy up to 5 months postpartum.
  • The incidence of PPCM is 1 in 1000–4000 pregnancies in the United States.1

Etiology

  • The etiology of PPCM remains unclear. There is evidence to support viral triggers, including coxsackievirus, parvovirus B19, adenovirus, and herpesvirus, which 
may replicate unchecked in the reduced immunologic state brought on by pregnancy.2,3
  • Fetal microchimerism, wherein fetal cells escape into the maternal circulation and induce an autoimmune myocarditis, has also been suggested as a cause.4
  • A cleavage product of prolactin has been implicated in the development of PPCM.5 Other vasculo-hormonal pathways have also been suggested to post a toxic challenge to the heart and lead to PPCM.1

Risk Factors

Risk factors that predispose a woman to PPCM include advanced maternal age, multiparity, multiple pregnancies, preeclampsia, and gestational hypertension. There is a higher risk in African American women, but this may be confounded by the higher prevalence of hypertension in this population.

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