Peripartum Cardiomyopathy

Question 1

What is the ejection fraction needed for the diagnosis of peripartum cardiomyopathy

Answer 1

Less than 45%

Question 2

What are some additional findings on echocardiogram that is suggestive of peripartum cardiomyopathy

Answer 2

• Dilated left ventricle with an end diastolic dimension greater than 2.7cm/m2 of body surface area
• Shortening fraction less than 30%

Question 3

When can you see most cases of peripartum cardiomyopathy

Answer 3

Approximately 90% of cases occur in the first 2 months postpartum

Question 4

What is the incidence of peripartum cardiomyopathy

Answer 4

Occurs in 1 in 4000 live births

Question 5

List the risk factors for peripartum cardiomyopathy

Answer 5

African American race
Advanced maternal age
Multiparity
Multiple gestation 
Hypertensive disease in pregnancy

Question 6

Women with ejection fraction less than 25% and persistent dilation of left ventricle have an increased risk for?

Answer 6

Cardiac transplant. Approximately 57% receive or are on the wait list for transplant

There is a 19% mortality risk

There is a 44% risk for continued symptoms of cardiac failure

Question 7

Failure to normalize cardiac function within 6 months postpartum has what percentage risk for mortality in 5 years?

Answer 7

85%

Question 8

When would you consider anticoagulation in patient with peripartum cardiomyopathy

Answer 8

• significant left ventricular dilation - with end diastolic ventricular dimension >2.7cm/m2 of body surface area
• ejection fraction <35%
• atrial dysrhthmia

Question 9

What are the most common cause of death in peripartum cardiomyopathy

Answer 9

Dysrhythmia
Progressive cardiac failure
Venothromboembolism

Question 10

What is the most common dysrhythmia in peripartum cardiomyopathy

Answer 10

Most common dysrhythmia is atrial fibrillation

Question 11

Work up for patient with suspected cardiomyopathy

Answer 11

Echocardiogram 
Electrocardiogram
Chest X-ray 
BNP
Arterial blood gas

Question 12

List medical treatment of peripartum cardiomyopathy and why?

Answer 12

Diuretic such as furosemide 20-40mg PO daily to decrease preload

Digoxin 0.25-0.5mg PO daily to increase contractility

Carvedilol 3.25-25mg PO daily to decrease myocardial oxygen demand

Hydralazine 25-100mg to decrease afterload in pregnancy

Enalapril 5mg twice daily for afterload reduction postpartum

Pentoxifylline for inflammation reduction

Bromocriptine to decrease levels of 16 kDa fragment of prolactin which may induce myocardial damage

Question 13

Name three things to avoid in the management of patient with peripartum cardiomyopathy

Answer 13

Avoid hypertension
Avoid excessive fluid
Avoid increase in cardiac demand

Question 14

Is epidural safe for patient with peripartum cardiomyopathy

Answer 14

Yes! It decreases preload and myocardial demand by vasodilation and reduction in pain

Question 15

What lifestyle modifications would you recommend for patients with peripartum cardiomyopathy

Answer 15

Low salt diet - less than 4 grams per day
Fluid restriction - less than 2 liters per day
Activity limitation

Question 16

What arterial pressure of oxygen should be maintained in patients with cardiac disease in the intrapartum period

Answer 16

PaO2 greater than or equal to 70mmHg

Question 17

Classic diagnosis of peripartum cardiomyopathy include:

Answer 17

Development of heart failure in the last 4 weeks of pregnancy up to 5 months postpartum

Absence of other identifiable causes

Absence of previous heart disease prior to the last four weeks of pregnancy

Question 18

What test should be performed in the preconception period for a patient with a history of peripartum cardiomyopathy

Answer 18

Stress echocardiogram

Question 19

Patients with ejection fraction less than this should be advised against pregnancy in the preconception period

Answer 19

Patients with ejection fraction less than 50% because of an increased risk for cardiac decompensation

Question 20

Recurrence rate of peripartum cardiomyopathy in subsequent pregnancy

Answer 20

50% especially in those who do not have complete recovery of the left ventricular function