Gestational and Post-Pregnancy Heart Failure – Treatment of Peripartum Cardiomyopathy

Gestational and Post-Pregnancy Heart Failure – Treatment of Peripartum Cardiomyopathy

Holding your newborn baby in hands makes you feel like your heart is bursting with love. However, in some rare cases in pregnancy or after delivery, a mother can develop another change in heart that could be deadly for her well-being. This condition is known as peripartum cardiomyopathy. Scroll down to know more about this heart condition in pregnancy.

Peripartum cardiomyopathy

Peripartum cardiomyopathy is a kind of rare heart failure. This condition can occur during last month of pregnancy or within six months after the delivery. Peripartum cardiomyopathy weakens the muscles of the heart causing it to become enlarged. This reduces the capability of the heart to pump the blood effectively and as a result, a heart attack can occur.

How common is peripartum cardiomyopathy?

As per American Heart Association, this condition affects about 1000-1300 women in the United States every year. Most women are diagnosed in the last month of their pregnancies or within five months after the delivery.

Causes and risk factors - Why heart failure occurs in pregnant women?

In pregnancy, the responsibility of the heart pumping the blood increases to 50 percent. This is because the pregnant woman has to transfer vital nutrients and oxygen to her developing baby. So, the heart has to apply extra effort. However, this is not the definitive cause of this disease.

Experts believe that extra blood pumping combined with some other risk factors puts additional stress on the heart. This can lead to congenital heart failure. Various risk factors can play a role in the development of this condition. These include:

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Signs of peripartum cardiomyopathy – Watch out for these symptoms

Signs of peripartum cardiomyopathy are similar to that of heart failure. The pregnant woman may feel:

  • Rapid heartbeat or palpitation
  • Chest pain
  • Shortness of breath
  • Excessive fatigue
  • Swelling of ankles and feet
  • Swelling of neck veins
  • Tiredness during physical activities
  • Increased frequency of urination at night (nocturia)

Possible complications of peripartum cardiomyopathy – How serious it could be

The condition mainly affects the heart but other organs such as lungs can also be affected. Following complications can occur due to peripartum cardiomyopathy.

  • Abnormal rate of muscle contractions in the heart (Arrhythmia)
  • Congestive heart failure
  • Formation of blood clots, especially in the lungs
  • Death

Diagnostic procedure of peripartum cardiomyopathy

After reviewing your symptoms, the doctor would ask about your medical history followed by physical examination and imaging tests.

Physical examination

The doctor will be using a stethoscope to check for crackling noise in the lungs as well as abnormal sounds in the heart. You might have to undergo blood pressure test. It might be lower than normal and drops significantly when you stand up.

Imaging test

Numerous imaging tests can determine the heart, rate of blood flow and damage to the lungs.

  • X-ray examination of the chest can reveal the congestion of the lungs or veins in the lungs
  • CT scan can provide detail picture of the heart.
  • Nuclear heart scan uses radioactive material which is injected into the veins and a special camera trace this substance as it moves. This can reveal the heart chambers.
  • In echocardiogram, sound waves are produced to create moving pictures of the heart. This is more detailed than that of X-ray.

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What are the best options to treat peripartum cardiomyopathy?

Typically, a pregnant woman who has been diagnosed with this condition has to stay in the hospital for treatment. Depending on the severity of the symptoms, the doctor would plan the treatment accordingly. Heart damage due to this condition is irreversible. However, depending on the damage, the heart will continue to function for a long time.

Basically, the condition is treated with medication and heart transplant, depending on the severity of the damage.

Medication

The following medications can be prescribed to control the symptoms:

Beta-blockers - Blocks the adrenaline hormone which in turn, reduces blood pressure and improves blood flow

Digitalis - These drugs are given to boost the pumping and circulation capability of the heart

Diuretics - These medications remove excess of salt and water from the body, lowering the blood pressure

Anticoagulants – These drugs are recommended for thinning the blood.

Women may have to follow a low-salt diet in order to keep their blood pressure under control. They have to avoid smoking and alcohol as these things can make their symptoms worse. 

Heart transplant surgery and outlook

The seriousness of the damage will decide whether a heart transplant is needed or not. The heart health of 30-50 percent of women with peripartum cardiomyopathy will return to normal after delivery. However, about 4 percent of cases will require heart transplant and 9 percent women die as a result of surgery.

In severe cases, balloon heart transplant is recommended. However, even after successful treatment, the condition can affect a woman for the rest of her life. The treatment for most of the women involves monitoring the symptoms and reducing them.

Prevention tips of peripartum cardiomyopathy

This heart disorder can be prevented right to some extent. By changing lifestyle, a pregnant woman, especially the first time mothers can do a lot to decrease the chances of getting this condition. Here are some tips which can make a world of difference:

If you have a history of heart failure during pregnancy, the gynecologist may suggest you to avoid getting pregnant again. This would be the best option in your favor.

Sources

1. Zolt Arany and Uri Elkayam(2016). Peripartum Cardiomyopathy read more
2. Barouch's L(n.d.). Peripartum Cardiomyopathy Johns Hopkins Medicine read more 
3. Peripartum Cardiomyopathy (PPCM)(2015, July). American Heart Association read more
4. Peripartum cardiomyopathy(2016, May 05). MedlinePlus read more
5. Peripartum cardiomyopathy: review and practice guidelines(2012, March). AICC read more