Peripartum Cardiomyopathy

Aka: Peripartum Cardiomyopathy, Postpartum Cardiomyopathy

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II. Definitions

  1. Postpartum Cardiomyopathy
    1. Left Ventricular Systolic Dysfunction onset in late pregnancy or first 4 months postpartum

III. Epidemiology

  1. Incidence: 1:1000 to 4000 mothers of live births
  2. Onset
    1. Typical: First week after delivery (up to the first month)
    2. Range: Second trimester to 4 months postpartum

IV. Pathophysiology

  1. Left Ventricular Systolic Dysfunction onset in late pregnancy or first 4 months postpartum

V. Risk Factors

  1. Advanced maternal age
  2. Preeclampsia
  3. Hypertension
  4. History of Peripartum Cardiomyopathy with prior pregnancy
  5. Multiple Gestation
  6. Multigravida
  7. Black race
  8. Poverty
  9. Cocaine Abuse
  10. Prolonged exposure to Tocolytic medications >4 weeks
    1. Bassett (1985) Obstet Gynecol 66(6): 755-61 [PubMed]

VI. Findings

  1. See Congestive Heart Failure
  2. Dyspnea on exertion
  3. Paroxysmal Dyspnea on exertion
  4. Orthopnea
  5. Lower Extremity Edema

VII. Labs

  1. See Congestive Heart Failure
  2. Serum Chemistry Panel
  3. Brain Natriuretic Peptide

VIII. Differential Diagnosis

  1. See Cardiomyopathy
  2. Preeclampsia
  3. Postpartum Cardiomyopathy is a diagnosis of exclusion when no other Cardiomyopathy cause is identified

IX. Imaging

  1. Chest XRay

X. Diagnostics

  1. Electrocardiogram
    1. May be normal or only demonstrate Sinus Tachycardia
  2. Echocardiogram
    1. First-line study
    2. Have a low threshold for obtaining echo when symptoms are out of proportion to pregnant/Postpartum State

XI. Management

  1. See Congestive Heart Failure
  2. Pregnancy precautions
    1. Avoid ACE Inhibitors and Angiotensin Receptor Blockers
    2. Exercise caution with Diuretics (risk of Hypotension and uterine hypoperfusion)
  3. Lactation precautions
    1. Metoprolol and Spironolactone are preferred
    2. Exercise caution with ACE Inhibitors or ARBs

XII. Prognosis

  1. Mortality (longterm): 11-16% (up to 20%)
    1. Mortality rates are higher in black women
  2. Most women recover from Postpartum Cardiomyopathy
    1. Some women may have persistently reduced ejection fraction
    2. Future pregnancy mortality approaches 25% if ejection fraction has not returned to normal
    3. Hilfiker-Kleiner (2017) Eur J Heart Fail 19(12): 1723-8 [PubMed]

XIII. References

  1. Lively and Clare (2022) Crit Dec Emerg Med 36(5): 4-10
  2. Brieler (2017) Am Fam Physician 96(10):640-6 [PubMed]
  3. Coppiano (2026) Am Fam Physician 113(2): 166-73 [PubMed]
  4. Sliwa (2010) Eur J Heart Fail 12(8): 767-8 [PubMed]

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