What is Peripartum cardiomyopathy?
Peripartum cardiomyopathy (PPCM) is a rare form of cardiomyopathy that occurs in pregnant women and recent mothers, and is often misdiagnosed. PPCM causes your heart to become larger around the time of your delivery. This enlargement weakens your heart muscle and makes pumping blood more difficult. This means your left ventricle cannot function properly (also known as a reduced ejection fraction, or EF). When your blood can’t circulate well enough to support vital organs, it can lead to heart failure.
Who is at risk?
PPCM can happen in the last month of pregnancy and up to five months after you give birth. It can affect you even if you have no previous signs of heart disease. Healthy women with no risk factors have experienced PPCM. However, there are factors that can increase your risk of developing this condition.
Risk factors include:
- multiple pregnancies
- giving birth to twins
- pre-eclampsia and eclampsia
- a history of cardiac disorders
- excessive alcohol consumption
- diabetes
- smoking
- obesity
- African heritage
- unhealthy diet
Causes
The exact cause of PPCM is unknown. Here is what is known:
- There are strong links between PPCM and high blood pressure (hypertensive disorders).
- A combination of preeclampsia and a protein that stops new blood vessels from forming could be another cause.
- Pregnancy places a strain on your heart muscle which may weaken your heart to the point of heart failure.
- High levels of the hormone that stimulates milk production (prolactin) may be another trigger.
- An inflamed heart muscle because of a viral infection or autoimmune disorder has also been associated with PPCM.
There are other cardiac conditions that can look like PPCM, including:
- coronary artery spasm
- spontaneous coronary artery dissection
- coronary artery disease and small-vessel disease
- valvular heart disease, including mitral stenosis
- other forms of dilated cardiomyopathy
Symptoms
PPCM can be difficult to diagnose because many of the symptoms of a weakened heart muscle can also be experienced by healthy pregnant women during their last trimester.
These symptoms include:
- breathlessness / shortness of breath when lying down
- exhaustion / low energy
- coughing
- swollen legs, ankles or hands
- weight gain
Other symptoms also associated with PPCM include:
- palpitations or feelings of missed heartbeats
- peeing more often at night
- stomach pain / abdominal discomfort
- coughing up blood (hemoptysis)
- fainting
Diagnosis
PPCM is a diagnosis of exclusion, meaning your doctor will rule out other more common conditions before making a diagnosis of PPCM. A blood test measuring a protein produced by the heart and blood vessels (brain natriuretic peptide (BNP) levels) could help show that you have a distressed or damaged heart.
A doctor may also look for fluid in your lungs as an indication of PPCM. Other tests that could be done include:
In some cases, a cardiac catheterization or a heart muscle biopsy might be done.
Treatment
After a diagnosis of PPCM, you will be closely watched by your healthcare team. A weight gain of three to four pounds over two or more days may mean a build-up of fluid in your lungs and a flare up of PPCM. Treatment decisions will depend on if you are pregnant and how far along your pregnancy is. A multidisciplinary healthcare team (including a cardiologist, obstetrician and pediatrician) will help to determine the best treatments for you.
Medication
Medications that may be prescribed include:
- beta-blockers
- diuretics
- anticoagulants
- bromocriptine (blocks the release of a hormone called prolactin from the pituitary gland)
Surgery and other procedures
Sometimes medications and lifestyle changes may not work for you and surgery is needed. These techniques could include:
In more extreme cases a heart transplant or a ventricle-assist device may be needed.
Lifestyle
Additional pregnancies are discouraged because the odds of PPCM happening again are high. Other lifestyle changes could include:
- a low fat / low salt diet
- monitoring weight
- avoiding smoking and alcohol
- speaking to your doctor about what kind of exercise is good for you.
Living with PPCM
In a recent study, one in three PPCM survivors experienced symptoms of depression. You could experience mental health challenges following a diagnosis of PPCM, which may make healthy changes more difficult. Find someone you can turn to for emotional support like a family member, friend, doctor, mental health worker or support group. Talking about your challenges and feelings could be an important part of your journey to recovery.
There are support groups and online communities you can join to help you cope with the effects of PPCM and connect with other survivors:
Research
Research is underway to better understand PPCM and to develop new treatments. Currently, researchers are investigating the following as having possible links to PPCM:
- cardiotropic viruses
- autoimmunity or immune system dysfunction
- toxins that serve as trigger to immune system dysfunction
- micronutrient or trace mineral deficiencies
- genetics
Canadian researchers are looking at how a drug called bromocriptine could relieve suffering in PPCM patients. Read more on this exciting study.
Researchers have also looked at the difference between PPCM outcomes in Indigenous women and non-Indigenous women. Their study was the first of its kind and found significant differences that you can learn more about here.
