The Heart of Pregnancy: Understanding peripartum cardiomyopathy

By Tracy Wright

Pregnancy is difficult enough with weight gain, hormonal mood swings and morning sickness. But there is a condition that can put pregnant women in a lethal position. Peripartum cardiomyopathy (PPCM), also known as postpartum cardiomyopathy, is an uncommon form of heart failure that happens during the last month of pregnancy or up to five months after giving birth.

Cardiomyopathy literally means heart muscle disease. In PPCM the heart chambers enlarge and the muscle weakens, leading to less blood. This causes the heart to no longer able to meet the demands of the body's organs for oxygen, affecting the lungs and liver, among other body systems.

According to the American Heart Association, about 1,000 to 1,300 women develop the condition in the U.S. each year and is most common with women over 30 years old. Women at the highest risk had higher blood pressure, a higher rate of gestational hypertension, and a higher rate of suspected respiratory infection. Research has also shown connections with factors such as obesity, mood disorders, substance abuse and autoimmune disorders. The American College of Cardiology also found that African-American women are most predisposed to develop PPCM.

PPCM may be difficult to detect because symptoms of heart failure (swelling in the feet and legs, shortness of breath, etc.) are often very similar to those of third trimester pregnancy. If PPCM is suspected, doctors will look for signs of fluid in the lungs and will listen for lung crackles, a rapid heart rate or abnormal heart sounds. If those conditions are met, an echocardiogram can can be used to detect the diminished functioning of the heart.

Once a patient is diagnosed with PPCM, treatment can include several kinds of medications to treat symptoms in order to prevent fluid from accumulating in the lungs and help the heart to recover. Medications may be ACE (angiotensin converting enzyme) inhibitors to recover the heart’s strength, Beta blockers to cause the heart to beat more slowly for recovery and diuretics to help reduce fluid retention.

If PPCM is diagnosed prior to delivery, a mother’s medical team should work closely together and develop an individualized plan based on the patient’s symptoms and status. Research published in the Journal of the American College of Cardiology recommends vaginal delivery be attempted unless there is an identified complication. The risk to the patient is believed to be less with vaginal delivery than with cesarean delivery.

So, what about mothers who have experienced PPCM and want to get pregnant again?

“As recently as a decade ago, there was very little data about the risk to either the mother or baby. It has become evident, however, that the risk of a subsequent pregnancy for the mother’s heart depends on whether — and how soon — her heart’s pumping ability returns to normal,” Jane Houston, a licensed certified nurse midwife and clinical director for midwifery and women’s health at Frontier Nursing University, said.

Mothers wishing to conceive again should ask their doctor or health care provider for a preconception referral to a cardiologist who has knowledge of peripartum cardiomyopathy management.

“Women who have a history of PPCM and are considering repeat pregnancy should be assessed by their obstetrician and a cardiologist to discuss the risks and benefits on a patient by patient basis,” said Ki Park, a clinical assistant professor of medicine in interventional cardiology at UF Health.