A type of cardiomyopathy that occurs only in the last month of pregnancy or within 5 months after delivery is called peripartum cardiomyopathy (PC). Generally, this disorder causes a weakness of the heart muscle. Furthermore, if you leave this condition untreated, it may lead to heart failure and even death. Extreme tiredness (fatigue), heart palpitations, and dyspnea (trouble breathing) are the most common symptoms of PC.
However, this condition occurs quite rarely, and it reduces the heart’s ability to pump blood for the body’s needs. Sometimes, it is called pregnancy-associated cardiomyopathy. Once PC occurs, it causes damage to one of the heart chambers (left ventricle) that affects the heart’s ability to pump blood. This chamber of the heart is very important because it pumps oxygen-rich blood to the rest of the body.
Some people might hear doctors who use the term “left ventricular ejection fraction” (LVEF), which refers to the ability of the left ventricle to pump blood out of the heart muscle. LVEF is often checked with an echocardiogram. Thus, doctors describe LVEF as a percentage, and a higher number is better. For instance, if the LVEF is 50% to 70% it is considered normal. In people with PC, the LVEF level is below 45%.
To increase the recovery chances, early diagnosis and proper treatment are important.
Peripartum cardiomyopathy happens quite rarely, and it affects about 1 in 1,000 to 4,000 pregnancies. According to some data, PC affects mostly pregnant women in the southern U.S. compared to other regions.
Symptoms
Usually, it is difficult to understand that you have PC because multiple symptoms also occur due to pregnancy. Check below some symptoms that may indicate PC:
- Shortness of breath that occurs when you are trying to sleep, lying down, or performing physical activity
- Extreme tiredness (fatigue)
- Edema (swelling in the ankles and feet)
- Heart palpitations
- Dry cough
- Swelling of the neck veins
- Lightheadedness
- Hypotension (low blood pressure)
- Chest pain
While most times this disorder affects pregnant women in the last month of pregnancy or later, it may also happen sooner. In some cases, you can put extra strain on the heart and worsen a previously undiagnosed heart disorder. That’s why it is very important to see a doctor if any of the symptoms listed above appear.
Causes
Healthcare providers do not fully understand why this condition occurs. However, they think hormonal changes during pregnancy and other disorders (such as preeclampsia) could play a role. Some experts believe there is a combination of multiple factors.
Moreover, PC may be hereditary, meaning it can be passed from biological parents to their children during pregnancy, but there is no research to prove this theory. In any case, approximately 15% to 20% of pregnant women who have developed PC have genetic mutations. Some doctors believe that genetic mutations, along with the stress of pregnancy and delivery, can trigger cardiomyopathy symptoms. That’s why it is very important to evaluate your medical and family history of heart diseases (specifically cardiomyopathy).
Risk Factors
PC has multiple risk factors, and the more risk factors you have, the more you are likely to develop this disorder. Check below some factors that may increase your risk of PC before pregnancy:
- Hypertension (high blood pressure)
- Obesity (excessive body weight)
- Diabetes
- Substance use disorder
- Selenium and Zinc deficiency
Check below also some factors that are related to pregnancy:
- Technologies (such as IVF) to help get pregnant
- Prior diagnosis of peripartum cardiomyopathy
- Pregnancy with twins or triplets
- Being pregnant for the first time
In addition, there are some complications that may occur during pregnancy and also increase your risk of PC. These include:
- Asthma
- Autoimmune disorders
- Prolonged use of certain medicines used to delay delivery if you have preterm contractions
- Thyroid disease
- Anemia (low red blood cell count)
- Eclampsia and preeclampsia
Considerations for Black Women
According to some research, Black females should consider the following factors before becoming pregnant. For example:
- They have an increased risk of PC
- Can get the diagnosis at a younger age (27) or later in the postpartum period
- Higher risk of dying from PC
- They also have an increased risk of developing life-threatening complications
- More severe heart damage and reduced ability to pump blood from the PC
What Happens if Postpartum Cardiomyopathy is Left Untreated?
The following complications often occur because the heart muscle cannot pump enough blood for the body’s needs. As a result, it may lead to serious and even life-threatening complications. These include:
- Blood clots
- Thrombosis
- Heart failure
- Cardiogenic shock
- Arrhythmia (irregular heart rhythm)
- Permanent damage to the brain
- Stroke
- Pulmonary edema (it occurs when fluid builds up in the lungs)
- Death
This document does not contain a complete list of PC complications. However, you can consult with your healthcare provider about ways to reduce the risk of developing previous complications.
How to Prevent Peripartum Cardiomyopathy?
One of the best ways to prevent this disorder is to keep your heart healthy. Unfortunately, not all factors that increase the risk of PC can be prevented. Check below some tips that may help reduce the risk:
- Regular physical activity
- Quit smoking (if you have problems with smoking cessation, discuss it with your healthcare professional)
- Regularly check your blood pressure and get treatment when needed
- Try to get and maintain a healthy weight
- Avoid alcoholic drinks, especially during pregnancy
- Eat heart-healthy foods
Diagnosis
Usually, doctors diagnose PC if you meet the following criteria. Examples include:
- You experience heart failure near the end of the pregnancy or within 5 months after childbirth
- Doctors cannot identify the exact cause of heart failure
- Echocardiogram shows your LVEF is lower than 45%
Physicians may also ask some questions about your symptoms and evaluate your medical history to get more clues about the disease. While there are no specific tests to confirm PC, doctors may perform the following tests to reveal any heart problems that were present before pregnancy. In some cases, people have heart problems, but the symptoms begin after becoming pregnant. Check below some tests often performed by doctors:
- Blood tests
- Electrocardiogram (ECG or EKG)
- Chest X-ray
- Echocardiogram (also known as echo)
- Heart MRI (magnetic resonance imaging)
- Heart catheterization
- Myocardial biopsy – During this procedure, doctors will take a small sample of the heart for testing.
Treatment
The treatment goal is to relieve the symptoms, prevent serious complications, and restore the heart’s ability to pump blood. It is important to understand that this disorder does not go away on its own and requires treatment once it happens. Once you are diagnosed with PC, doctors will make sure the medicines they prescribe are safe for the fetus. Check below some treatments often recommended for people with peripartum cardiomyopathy:
- Angiotensin-converting enzyme (ACE) inhibitors
- Angiotensin II receptor blockers (ARBs)
- Angiotensin receptor/neprilysin inhibitors (ARNIs)
- Beta-blockers
- Diuretics
- Hydralazine/nitrates
- Mineralcorticoid receptor antagonists (MRAs)
- Anticoagulants (also known as blood-thinners)
- Sodium-glucose cotransporter-2 (SGLT2) inhibitors
In more severe cases, people may need one of the following treatments. For example:
- Cardiac devices – These devices are used as cardiac defibrillators.
- A left ventricular assist device (LVAD)
- Heart transplant – This treatment option is often recommended for people with very low LVEF who do not respond to other treatments.
In addition, previous treatments may also cause some adverse reactions. For instance, if you are administering beta-blockers, they can cause hypoglycemia, bradycardia, or heart block in your baby. For more details, discuss it with your doctor.
Frequently Asked Questions
How soon after treatment will I feel better?
In most cases, people recover completely from PC within 6 months of treatment. However, if you develop a mild form of PC, the treatment may last a few days or weeks.
When should I go to the ER?
Call 911 or go to the nearest emergency room (ER) if you experience new symptoms or worsening of existing ones.
What is the life expectancy of someone with peripartum cardiomyopathy?
In general, the life expectancy of people with PC is highly variable. However, about 50% of women with this disorder experience a complete recovery of the heart muscle. The mortality rate often varies by region and ethnicity, but can be as high as 20% within 1-2 years of diagnosis. Ask your healthcare provider if you have additional questions.
