Peripartum cardiomyopathy in young women

• Published in: Nederlands tijdschrift voor geneeskunde Vol. 155; p. A2937
• Main Authors: Lok, Sjoukje I, Doevendans, Pieter A F, Klöpping, Corinne, Kirkels, J Hans, Lahpor, Jaap R, de Jonge, Nicolaas
• Format: Journal Article
• Language: Dutch
• Published: Netherlands 2011
• Subjects: Adult; Cardiomyopathy, Dilated - diagnosis; Delivery, Obstetric; Female; Humans; Peripartum Period; Pregnancy; Pregnancy Complications, Cardiovascular - diagnosis; Pregnancy Outcome
• ISSN: 0028-2162; 1876-8784

Two women aged 26 and 41 were diagnosed with peripartum cardiomyopathy (PPCM). They presented with shortness of breath and oedematous ankles. The first woman presented in her 37th week of pregnancy. Her father had had dilated cardiomyopathy. A caesarean section was carried out. Her left ventricular function declined and she was therefore treated by means of an Impella heart pump and later, a left-ventricular assisting device. She eventually underwent urgent heart transplantation and recovered. The second woman presented 6 weeks after having given birth to twins. She was treated with a diuretic, an ACE inhibitor, a beta blocker and recovered. PPCM is a rare and potentially life-threatening form of dilated cardiomyopathy with left-ventricular systolic dysfunction that affects women in late pregnancy or in the early puerperium. Its pathogenesis is poorly understood. The generation of a cardiotoxic prolactin subfragment appears to play a key role in the pathophysiology. PPCM is difficult to diagnose as the initial complaints may be interpreted as the normal physiologic changes of pregnancy. In addition, prior definitions emphasising strict time windows, the lack of awareness and the rarity of the full-blown disease have sometimes resulted in the condition being overlooked and misdiagnosed.