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Peripartum Cardiomyopathy (PPCM): Causes, Symptoms, Diagnosis And Treatment

by — 2020-01-03 in Cardiovascular Disorders and Diseases
What are the causes and risk factors of peripartum cardiomyopathy? How can peripartum cardiomyopathy be diagnosed? We delve into the topic to find out more about the condition.

Peripartum cardiomyopathy (PPCM) is a rare kind of heart disease that occurs towards the end of pregnancy and, in some cases, within five months of childbirth. It is also called postpartum cardiomyopathy.  

While cardiomyopathy is a disease of the heart muscle, peripartum cardiomyopathy is the dilated type. In PPCM, the chambers of the heart become enlarged, accompanied by a weakening of the heart muscle. The result is a reduction in blood flowing out from the left ventricle (bottom heart chamber) during contraction. What you then have is inadequate general blood flow while the heart becomes increasingly unable to supply the body. Over time, vital systems and organs in the body are affected, like the liver and lungs.

In the US, peripartum cardiomyopathy is rare and only an estimated 1,000 to 1,300 women experience the condition each year. There are countries where this disease is more prevalent, due to factors like diet, genetics, general lifestyle, and a wide range of medical conditions.

What are the causes and risk factors of peripartum cardiomyopathy?

In some situations, heart muscle inflammation is seen in women who underwent a heart biopsy or had a viral illness in the past, or unusual immune responses may be the cause. Other factors that can cause PPCM are poor eating habits, bad defenses against antioxidants, small-vessel disease, and coronary artery spasm. Genetics can also be to blame.

In the past, peripartum cardiomyopathy was thought to occur mostly in women aged 30 years and above. Today, however, there are cases of PPCM in females in different age groups. This rare heart condition has some risk factors, which include:

  • Poor nutrition
  • Race – more prevalent in people of African-American heritage
  • Long-term use of alcohol
  • Long-term smoking
  • Using certain medications
  • Obesity
  • Multiple pregnancies
  • Cardiac disorder history

The symptoms of peripartum cardiomyopathy

PPCM has symptoms that are identical to those of heart failure. You might want to consult your medical health provider if you experience symptoms like:

  • Chest pain
  • Getting tired easily
  • Difficulty breathing
  • Frequent urination at night
  • Palpitations
  • Swollen ankles and feet

The fact that many of these symptoms are also associated with pregnancy makes it harder for women to recognize that something may be wrong, but be sure to discuss your symptoms with your OBGYN.

Can peripartum cardiomyopathy be diagnosed?

After discussing symptoms with you, your doctor can carry out an analysis and conduct a physical examination. A stethoscope may come in handy as your doctor will try to check whether your heart makes unusual sounds or your lungs make crackling noises. There will also be blood pressure tests. 

There are imaging tests designed to analyze and measure your heart. Your blood flow rate will be determined through these tests. Imaging tests may be used to check signs of possible lung damage in the future. Some of these tests are:

  • CT scans to see clear pictures of your heart.
  • Sound waves that produce images of your heart as it moves (echocardiogram).
  • Tests to see the heart chambers using a nuclear heart scan.
  • An X-ray of your every area of your chest. 

Can peripartum cardiomyopathy be treated?

Women who suffer from peripartum cardiomyopathy stay under constant monitoring at a medical facility and are able to recover from symptoms. Medical professionals usually analyze how severe the condition is before making treatment recommendations. Heart damage resulting from PPCM cannot be reversed, however such a heart can continue to perform its functions for a long time. This will depend on how severe the damage is. To determine whether a PPCM patient requires a heart transplant, the level of damage caused by the condition will be analyzed. 

In the long-term, women who develop the condition but whose hearts become normal again post-delivery have good prospects. About 30 to 50 percent of PPCM cases return to normal but a heart transplant is needed in four percent of cases. Unfortunately, the heart transplant process results in death in nine percent of cases. 

Many women undergo treatment that helps manage and reduce symptoms. If peripartum cardiomyopathy is severe, medical professionals usually suggest a heart transplant. In other cases, a balloon heart pump is recommended. 

Some medications that women may have to use during PPCM to bring symptoms under control include:

  • Diuretics to help reduce blood pressure by getting rid of too much water and salt
  • Beta blockers to help optimize blood flow and lower blood pressure
  • Digitalis to provide heart strength for the improvement of pumping and circulation
Women who experience PPCM will be advised to adopt a low-salt diet as a way of managing blood pressure. Products that can worsen symptoms, like alcohol and tobacco, should be avoided. Patients may have to deal with the effects of peripartum cardiomyopathy throughout their lives, even after treatment. It is important to keep to medical appointments for regular monitoring and maintain strict adherence to instructions while taking medications. 

What women can to lower their PPCM risk

Positive lifestyle changes are important for women if they want to keep their hearts strong. Steering clear of alcohol and smoking is crucial for a healthy pregnancy and a healthy heart. Also, regular exercise and healthy nutrition are vital to heart health. Women who suffer from PPCM may develop the condition again if they get pregnant in the future. 

The future of peripartum cardiomyopathy

Professional investigations are ongoing to help medical experts understand what causes peripartum cardiomyopathy. This will help them to come up with even better solutions. Some forms of treatment like immunoabsorption as well as intravenous y-globulin are not yet proven as solutions even if doctors have used them.

There also are ongoing studies to understand whether prolactin has a role to play in peripartum cardiomyopathy. While it is suggested that bromocryptine may help to treat the disease, all these claims can only be verified through more research. 

Sources & Links

  • Photo courtesy of SteadyHealth

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