PPCM or postpartum cardiomyopathy is a rare form of heart failure with sudden onset in the last phase of pregnancy or within 5-6 months after delivery. Many cardiologists also refer to it as peripartum (around the time of childbirth) cardiomyopathy as it can also occur before the birth of a child. Dr Rajiv Agarwal – Senior Director & Unit Head – Cardiology, Max Smart Super Speciality Hospital, Saket says, “This condition is difficult to detect as the symptoms of the third trimester of pregnancy mimic those of heart failure”. The overlapping symptoms include fatigue, shortness of breath and swelling in legs and feet.
The Causes of Postpartum Cardiomyopathy
The exact cause of PPCM is still unknown. However, there is an indication that myocarditis (inflammation of the heart muscle) may play a vital role and may be related to the inflammatory proteins that are occasionally found in the blood during pregnancy. There is also an indication that fetal cells that rarely escape into the mother’s bloodstream can cause an immune reaction; thus, leading to inflammation of the heart muscle. Furthermore, healthcare specialists also associate postpartum cardiomyopathy as a genetic predisposition.
The Risk Factors for Postpartum Cardiomyopathy
Initially, PPCM was thought to be more common in women older than 30; however, there have been multiple cases reported across a wide range of age groups. The risk factors of PPCM include:
- Smoking
- Alcoholism
- Poor nutrition
- History of myocarditis
- Obesity
- Multiple pregnancies in the past
- Twin pregnancy
- Use of certain medications
How Can PPCM Be Treated?
Peripartum cardiomyopathy treatment aims at keeping extra fluid from collecting in the lungs. The objective is to recover the heart function. Many women recover normal heart function or stabilise on medicines. However, some cases do progress to severe heart failure which requires mechanical support or even heart transplantation.
There are various classes of medications that a cardiologist will prescribe for treatment. Some variations of these medications will only cater to women who are breastfeeding.
- Angiotensin-converting enzyme, or ACE, inhibitors – These medications help the heart work more efficiently. It can only be used after delivery as it may be harmful to the unborn child
- Beta-blockers – It causes the heart to beat slowly and have more recovery time
- Diuretics – These medications help in reducing fluid retention like furosemide and hydrochlorthiazide. In addition, torsemide and spironolactone may be used after delivery
- Digitalis – It is derived from the foxglove plant and is in use for more than 200 years to treat heart failure. It strengthens the pumping action of the heart
- Anticoagulants – These medications help in thinning the blood since patients with PPCM are at an elevated risk of developing blood clots
Cardiologists recommend a low-salt diet, restrict excess intake of fluids and keep a check on the patient’s weight by daily weighing. A weight gain of around a kilogram or more over a span of one or two days may signal fluid buildup. Women who drink alcohol and smoke are advised to quit, since these habits may make the symptoms worse.
Long-Term Considerations for Postpartum Cardiomyopathy
Many patients with peripartum cardiomyopathy may have complete recovery of heart function and the prognosis has improved in recent years with early diagnosis and proper treatment. It is particularly imperative to know that women who have had postpartum cardiomyopathy are at a high risk of developing the condition again with subsequent pregnancies, even those who seem to have made a complete recovery. The risk of severe and permanent cardiac damage becomes high if postpartum cardiomyopathy occurs for the second time. Therefore, those who have experienced it in their first pregnancy should get themselves checked at the best cardiac hospital in India to keep a tab on their health. Furthermore, cardiologists also advise that those who have had postpartum cardiomyopathy in whom heart function remains depressed should take steps to avoid getting pregnant again.
Research and future directions
Ongoing research is looking at the exact causation of peripartum cardiomyopathy and the role of drugs like bromocriptine in treatment of this condition.
