Peripartum Cardiomyopathy

Overview

What is peripartum cardiomyopathy (PPCM)?

Peripartum cardiomyopathy (PPCM) is a rare form of congestive heart failure that is associated with pregnancy. The condition has not been linked to any other condition or cause. If you have peripartum cardiomyopathy, your heart becomes weak and larger than normal. Most times, PPCM occurs in the last trimester of pregnancy or the first month after delivery, but sometimes it takes up to 6 months after delivery for the condition to occur.

Who is at risk for PPCM?

Some risk factors for developing PPCM include high blood pressure, obesity, African-American race, being pregnant with multiples (twins or higher) and poor nutritional status.

Symptoms and Causes

What are the symptoms of PPCM?

Common symptoms of PPCM are symptoms of heart failure, such as

  • Shortness of breath
  • Swelling in the legs
  • Feeling tired
  • Heart palpitations (feeling that your heart is racing)

Diagnosis and Tests

How is PPCM diagnosed?

If your doctor thinks you may have PPCM, you will likely have an echocardiogram to confirm the diagnosis. An echocardiogram is an ultrasound of the heart.

Management and Treatment

What treatment options are available for patients with PPCM?

If you have PPCM, you will likely need to take medications to:

  • Help your heart squeeze the blood out to the rest of your body.
  • Get rid of extra water from your lungs and body
  • Relax your blood vessels and lower your blood pressure to relieve some of the strain on your heart.

You may also be asked to make changes in your diet such as limit sodium (salt) and fluids.

During this time, your doctor will tell you if you have any activity restrictions or if you will need to monitor weight or blood pressure, and how often you will need to return for visits to check you and your baby.

In some severe cases, surgery is needed to insert a balloon heart pump or perform a heart transplant.

Outlook / Prognosis

How does PPCM affect me in the long-term?

Fortunately, most women with PPCM will recover some, if not all of their heart function. But, close follow-up care on a regular basis is needed. Your doctor will let you know how often you need to be seen.

If you are considering another pregnancy, it is very important to talk to your doctor to assess your risks. If echocardiograms show that a patient’s heart remains weak, pregnancy is strongly discouraged. They are likely not able to handle the physical stress of pregnancy, and pregnancy could cause heart failure to become worse, the need for a heart transplant or cause death. Even patients whose echocardiograms show that their hearts have fully recovered after pregnancy could again develop heart failure if they become pregnant.

A thorough evaluation by a cardiologist and detailed discussion of the risks of pregnancy with a maternal-fetal medicine (high-risk pregnancy) specialist are recommended for any patient with a history of PPCM prior to conceiving.

Resources

Doctors who treat peripartum cardiomyopathy

The Cardio-Obstetric Clinic offers specialized diagnosis and care to women who have peripartum cardiomyopathy or those who have a history of PPCM and want to become pregnant – or who are pregnant and find they have heart disease.

Last reviewed by a Cleveland Clinic medical professional on 01/09/2019.

References

  • Naderi S, Raymond R, Pregnancy and Heart Disease, Cleveland Clinic Disease Management.
  • Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC), ESC Guidelines on the management of cardiovascular diseases during pregnancy, European Heart Journal (2011) 32, 3147–3197, doi:10.1093/eurheartj/ehr218, http://www.escardio.org/static_file/Escardio/Guidelines/publications/PREGN%20Guidelines-Pregnancy-FT.pdf
  • McNamara DM, Elkayam U, Alharethi R, Damp J, Hsich E, Ewald G, Modi K, Alexis JD, Ramani GV, Semigran MJ, Haythe J, Markham DW, Marek J, Gorcsan J 3rd, Wu WC, Lin Y, Halder I, Pisarcik J, Cooper LT, Fett JD; IPAC Investigators. Clinical Outcomes for Peripartum Cardiomyopathy in North America: Results of the IPAC Study (Investigations of Pregnancy-Associated Cardiomyopathy). J Am Coll Cardiol. 2015 Aug 25;66(8):905-14. http://www.ncbi.nlm.nih.gov/pubmed/26293760
  • National Library of Medicine MedlinePlus, Peripartum cardiomyopathy, https://www.nlm.nih.gov/medlineplus/ency/article/000188.htm

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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy