Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ KEY FEATURES +++ ESSENTIALS OF DIAGNOSIS ++ Development of cardiomyopathy with left ventricular dysfunction during the last trimester of pregnancy or in the early postpartum period Absence of other etiologies of cardiomyopathy No history of heart disease +++ GENERAL CONSIDERATIONS ++ The incidence in the United States ranges from 1 in 1000 to 4000 live births The etiology is unclear, but the pathophysiology involves impaired angiogenic signaling and oxidative stress. Recent data suggest that peripartum cardiomyopathy may share a genetic origin with familial and sporadic dilated cardiomyopathy More common in multiparous women. Preeclampsia and hypertension strongly predispose Can affect women of any age, but > 50% of cases occur in women > 30 years of age More common in black women +++ CLINICAL PRESENTATION +++ SYMPTOMS AND SIGNS ++ Symptoms may be difficult to differentiate from those of normal pregnancy Dyspnea Dizziness Fatigue Orthopnea Reduced exercise capacity Cough Palpitations Hemoptysis Chest pain Abdominal pain +++ PHYSICAL EXAM FINDINGS ++ Tachypnea Tachycardia Elevated jugular venous pressure Pulmonary rales Diffuse, sustained apical impulse Murmurs of tricuspid and mitral regurgitation S3 gallop Accentuated P2 Hepatomegaly Abdominal ascites Peripheral edema +++ DIFFERENTIAL DIAGNOSIS ++ Heart failure due to other causes Pulmonary causes: pulmonary embolus, pneumonia Acute pulmonary edema from prolonged tocolysis or preeclampsia Other cardiac causes: myocardial infarction or takotsubo cardiomyopathy +++ DIAGNOSTIC EVALUATION +++ LABORATORY TESTS ++ Levels of brain natriuretic peptide and troponin are typically elevated in peripartum cardiomyopathy and not usually elevated in normal pregnancy Tests to exclude preeclampsia (CBC, liver enzymes, urinalysis for proteinuria) Electrolytes, blood urea nitrogen, creatinine Thyroid function tests Serologic tests to exclude myocarditis (viral, HIV, rickettsial infection, syphilis, Chagas’ disease, diphtheria toxin) in suspected cases Serologic tests to exclude collagen vascular disease when indicated Urine toxicology to exclude cocaine and ethanol Urine metanephrines to exclude pheochromocytoma in suspected cases +++ ELECTROCARDIOGRAPHY ++ Sinus tachycardia Atrial fibrillation (rare) Low-voltage QRS Left ventricular hypertrophy Nonspecific ST- and T-wave abnormalities +++ IMAGING STUDIES ++ Chest x-ray: – Findings include cardiomegaly, pulmonary vascular congestion, pleural effusions Echocardiography findings include: – Abnormal enlargement of the left and sometimes the right ventricle – Reduced systolic ventricular function of varying degrees in a global pattern – Valvular regurgitation common – Elevated continuous-wave Doppler tricuspid regurgitant velocity indicating elevated pulmonary artery systolic pressure +++ DIAGNOSTIC PROCEDURES ++ Stress echocardiography: test of choice during pregnancy for patients with suspected coronary artery disease +++ TREATMENT +++ CARDIOLOGY REFERRAL ++ Reduced left ventricular function Congestive heart failure Tachyarrhythmias +++ HOSPITALIZATION CRITERIA ++ Congestive heart ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.