From the Guidelines
Peripartum cardiomyopathy (PPCM) typically presents with symptoms of heart failure, including shortness of breath, ankle swelling, and fatigue, which develop during the last month of pregnancy or up to 6 months after pregnancy. These symptoms can be nonspecific and similar to those experienced during normal pregnancy, making a high index of suspicion necessary for diagnosis 1.
Common Symptoms of PPCM
- Shortness of breath, especially when lying flat
- Persistent cough
- Swelling in the ankles and legs
- Fatigue
- Heart palpitations
- Chest pain
- Increased urination at night
- Decreased exercise tolerance
- Abdominal discomfort due to liver enlargement These symptoms occur due to the weakening of the heart muscle, which leads to inefficient blood pumping and fluid buildup in the lungs and other tissues 1.
Importance of Early Diagnosis
Early diagnosis and treatment of PPCM are crucial, as they significantly improve outcomes and can prevent progression of the disease, potentially allowing for heart recovery 1. Any pregnant or postpartum woman experiencing these symptoms should seek immediate medical attention. Prompt treatment with heart failure medications, adjusted for pregnancy safety, can help manage the condition and improve quality of life. It is essential to distinguish these symptoms from normal pregnancy changes to ensure timely intervention and prevent life-threatening complications such as arrhythmias, blood clots, or cardiogenic shock.
From the Research
Symptoms of Peripartum Cardiomyopathy (PPCM)
The symptoms of PPCM are similar to those of systolic heart failure and can include:
- Shortness of breath 2, 3, 4
- Fatigue 3
- Leg oedema (swelling of the legs) 3, 4
- These symptoms can be common in the peripartum period, making it essential to have a high index of suspicion for PPCM 3
Clinical Presentation
PPCM can present as heart failure with reduced ejection fraction (HFrEF) in the last month of pregnancy or in the months following delivery in women without another known cause of heart failure 3 The clinical presentation of PPCM can be complicated by a high incidence of thromboembolism 2 Other potential complications include arrhythmia 5
Diagnosis
Measurement of natriuretic peptides, electrocardiography, and echocardiography are recommended to promptly diagnose or exclude heart failure/PPCM 3 Diagnostic echocardiographic criteria include left ventricular ejection fraction <0.45 or M-mode fractional shortening <30% (or both) and end-diastolic dimension >2.7 cm/m(2) 6