Cardiomyopathy in Pregancy: Apostolakis-Kyrus Flashcards
What is GPTPAL?
G: Gravida: how many pregnancies
P: How many babies
TPAL?
T: Term
P: Preterm
A: Abortion
L: Living
What is a normal ejection fraction?
60-70%
What is a hysterotomy?
CSection for mother, needed for her survival
What is definition of peripartum cardiomyopathy?
Development of cardiac failure in the last month of pregnancy, or within 5 months of delivery
Absence of previous HF, no identifiable cause.
Left ventricular systolic dysfunction demonstrated by classic echo criteria: depressed shortening fraction or ejection franction
What is CM of pregnancy, in terms of diagnosis?
Diagnosis of exclusion
What are viral causes of peripartum cardiomyopathy?
ParvoB19
Herpes virus 6
Epstein Barr
CMV
What are risks for PPCM?
Chronic HTN PreEclampsia Obesity Smoking Hx of PP CM AMA Extremes of age AA multiple gestation: more work HIV
What is the main risk factor for PP CM ?
Chronic HTN
Pre Eclampsia
What are S/Sx of PP CHF?
Dypsnea Orthopnea Cough Palpitations Chest Pain
What do you see on CXR of PPCM?
Enlarged heart
Perihilar opacification
What is EF definition of PPCM?
TEST: Less than 45%
NOT TEST: Or fraction shortening less than 30%
Or both
Right ventricular end diastolic dimension greater than 2.7cm (WIDENING!)
What is broad Tx of PPCM?
Diuretics: reduce preload
Hydralazine: reduce after load
Digoxin: inotorpic, more efficient
Heparin: prophylactic for stroke
What is the immediate mortality of PPCM?
2%
What is important to counsel in terms of pregnancy after birth?
Do not get pregnant for the next year!
75% of peole need more than a year to get back up to an EF of >50%
Which is better, idiopathic myopathy or pregnancy myopathy?
Pregancy! most people recover within a year or two
What is 10 year survival of PP CM? Idopathic? HIV?
PP: >90%
Idio: ~60%
HIV: ~25%
We have to diagnose correctly!
What is the time breaking point for PP CM long term risk in terms of morbidity and mortality?
Recover within 6 months: great
Not recovered 6 months: higher
What percent of women will have CM in the next pregnancy?
About 1/5
TEST: Definition of PPCM?
- development within last onto or 5 months after birth
- absence of another cause
- absence of disease present before this one
- echo confirms EF/depressed shorteining fraction
