Author + information
- Received September 12, 2019
- Revision received November 6, 2019
- Accepted November 13, 2019
- Published online January 13, 2020.
- Melinda B. Davis, MDa,∗ (, )@MelindaDavisMD,
- Zolt Arany, MD, PhDb,
- Dennis M. McNamara, MD, MSc,
- Sorel Goland, MDd and
- Uri Elkayam, MDe
- aDepartment of Internal Medicine, Division of Cardiovascular Medicine and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
- bDepartment of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- cHeart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- dHeart Institute, Kaplan Medical Center, Rehovot, Hebrew University, Jerusalem, Israel
- eDepartment of Medicine, Division of Cardiovascular Medicine and Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles, California
- ↵∗Address for correspondence:
Dr. Melinda B. Davis, Division of Cardiovascular Medicine, 1500 East Medical Center Drive, SPC 5853, Ann Arbor, Michigan 48109-5853.
• Medications used to treat HF during pregnancy and lactation require special considerations.
• Severe HF may require advanced therapies and mechanical circulatory support.
• Subsequent pregnancies carry risk of relapse, and dedicated counseling and monitoring are essential.
• Future research about long-term outcomes, continued drug therapy, use of bromocriptine, device therapy, and genetics are needed.
Peripartum cardiomyopathy is a form of systolic heart failure affecting young women toward the end of pregnancy or in the months following delivery. Incidence is higher in African-American women and in women with older maternal age, hypertensive disorders of pregnancy, and multiple gestation pregnancies. Symptoms of heart failure mimic those of normal pregnancy, often resulting in a delay in diagnosis and preventable complications. Echocardiography showing decreased myocardial function is essential for the diagnosis. Medical management is similar to heart failure with reduced ejection fraction of other etiologies, but adjustments during pregnancy are necessary to ensure fetal safety. Variable outcomes include complete recovery, persistent heart failure, arrhythmias, thromboembolic events, and death. Subsequent pregnancy confers substantial risk of relapse and even death if there is incomplete myocardial recovery. Additional research about the etiology, optimal therapy including the use of bromocriptine, long-term outcomes, and duration of treatment after recovery are needed.
- dilated cardiomyopathy
- peripartum cardiomyopathy
- postpartum cardiomyopathy
- pregnancy-associated cardiomyopathy
Dr. Elkayam has received consulting fees from Abiomed and speaker fees from Zoll. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 12, 2019.
- Revision received November 6, 2019.
- Accepted November 13, 2019.
- 2020 American College of Cardiology Foundation
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