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Peripartum Cardiomyopathy

Peripartum Cardiomyopathy (PPCM)

Peripartum cardiomyopathy (PPCM) is a rare but severe heart condition that can occur anytime during the second half of pregnancy or in the several months following delivery. It happens when the heart muscle becomes weakened, making it harder for the heart to pump blood effectively.

Risk Factors

While PPCM can affect any pregnant person, risk factors may include:

High Blood Pressure

Preeclampsia or hypertension during pregnancy.

Black Race

Particularly African or Haitian heritage.

Multiple Pregnancies

Carrying twins, triplets, or more.

High Number of Pregnancies

Greater lifetime pregnancy count increases risk.

Maternal Age

Higher risk if age is over 30.

Heart History

Previous heart disease or PPCM.

Genetics & Lifestyle

Certain factors may contribute to PPCM risk.

Signs & Symptoms

PPCM symptoms can overlap with normal, common pregnancy or postpartum changes, so it’s important to recognize signs that may indicate a heart problem:

Shortness of Breath

Especially noticeable when lying flat or at rest.

Swelling

Swelling in legs, ankles, or feet that worsens.

Unexplained Cough

Cough that wakes you up at night without clear cause.

Palpitations

Rapid or irregular heartbeat sensations.

Fatigue

Persistent tiredness or feeling unusually weak.

Chest Pain

Discomfort or pain in the chest area.

Treatment

If you experience these symptoms, contact your healthcare provider immediately. If untreated, PPCM can lead to severe complications like heart failure or blood clots. However, with early diagnosis and proper treatment, many people recover fully. Your doctor may perform a physical exam and discuss your symptoms, perform imaging tests like an echocardiogram (heart ultrasound), and collect blood to test for heart strain or other related issues. Treatment focuses on improving your heart function and managing symptoms. This may include medications to strengthen the heart, lower blood pressure, or prevent blood clots. Lifestyle adjustments are also an important part of treatment. Your provider may recommend a low-salt diet, avoiding heavy physical activity, and close monitoring by specialists. In rare cases, devices like a defibrillator (a medical device that delivers a shock to the heart to restore normal rhythm) or even a heart transplant may be needed.

Importance of Ongoing Care and Disease Prevention

If you’ve had PPCM, future pregnancies may carry significant risks. Discussing family planning with your healthcare team to make informed decisions is essential. Even after treatment, follow-ups with a cardio-obstetric specialist are key to ensuring your heart health. Early intervention can make a life-saving difference.

References

  • Beech A, Mangos G. Management of hypertension in pregnancy. Aust Prescr. 2021 Oct;44(5):148-152. doi: 10.18773/austprescr.2021.039. Epub 2021 Oct 1. PMID: 34728879; PMCID: PMC8542489.
  • Brown, M. A., Magee, L. A., Kenny, L. C., Karumanchi, S. A., McCarthy, F. P., Saito, S., Hall, D. R., Warren, C. E., Adoyi, G., & Ishaku, S. (2018). Hypertensive disorders of pregnancy. Hypertension, 72(1), 24–43. doi: 10.1161/hypertensionaha.117.10803
  • Hameed, A. B., & Wolfe, D. S. (2020). Cardio-Obstetrics: A Practical Guide to Care for Pregnant Cardiac Patients. CRC Press.
  • Hypertensive Disorders of Pregnancy | Million Hearts®. (2024, July 30). Centers for Disease Control and Prevention. https://millionhearts.hhs.gov/tools-protocols/tools/hypertension-disorders-pregnancy.html
  • Khedagi AM, Bello NA. Hypertensive Disorders of Pregnancy. Cardiol Clin. 2021 Feb;39(1):77-90. doi: 10.1016/j.ccl.2020.09.005. Epub 2020 Nov 2. PMID: 33222817; PMCID: PMC7720658.
  • MW, Chojenta C, Muluneh MD, Loxton D. Factors associated with hypertensive disorders of pregnancy in sub-Saharan Africa: A systematic and meta-analysis. PLoS One. 2020 Aug 19;15(8):e0237476. doi: 10.1371/journal.pone.0237476. PMID: 32813709; PMCID: PMC7437911.
  • Signs and symptoms of preeclampsia. Preeclampsia Foundation – Saving Mothers and Babies from Preeclampsia. https://www.preeclampsia.org/signs-and-symptoms