Heart Failure During Or After Pregnancy: Expert Explains Peripartum Cardiomyopathy, Its Symptoms And Treatment

Pregnant women undergo various bodily changes and may also be prone to conditions like peripartum cardiomyopathy. It is a type of heart failure that occurs towards the end of pregnancy or in the months following delivery, where no other cause of heart failure is found. This disease was rare in the past, but recently there has been an increase in the numbers. To shed light on the same, we spoke to Dr C Raghu, Clinical Director and Senior Interventional Cardiologist, Yashoda Hospitals, Hyderabad, who explained this condition in detail.

What Is Peripartum Cardiomyopathy

Dr Raghu said, “Peripartum Cardiomyopathy (PPCM) is a condition that reduces the pumping efficiency of the heart. It affects women towards the end of pregnancy or early after delivery. Heart failure is a reduction in the functioning efficiency of the heart.” According to Johns Hopkins Medicine, in some cases, it takes six months or more for certain patients to regain only a portion of their heart function, while for others, the heart can fully recover in as little as two weeks.

Risk Factors Of PPCM

Dr Raghu listed the risk factors of PPCM as follows:

• Maternal age of 30 years or more
• African ancestry
• Hypertension
• Multiple gestations 
• Anaemia
• Substance misuse
• Asthma
• Autoimmune disease
• High blood pressure 

Also Read: Study Links Childhood Inactivity To Adult Cardiovascular Events, Expert Highlights Lifestyle Changes

Contributing Factors To PPCM

Dr Raghu added, “The presence of multiple risk factors exponentially increases the risk. The increasing prevalence of cardiovascular risk factors, such as hypertension, diabetes, and obesity among women of reproductive age has also contributed to this rising trend. Even in advanced countries like the USA, maternal mortality rates remain high due to the higher burden of cardiovascular diseases and 50% of these are due to PPCM.”

He added, “The exact cause for this disease remains elusive even though multiple hypotheses have been proposed. Certain countries in the world, such as Nigeria, and Haiti seem to have a higher prevalence of this disease, which is presumed to be due to a deficiency of selenium and zinc.”

Symptoms Of PPCM

Dr Raghu said, “Women with PPCM experience breathlessness on exertion or when lying flat or get woken up from sleep due to extreme breathlessness and swelling of feet. Most are present in the first month after delivery, but a significant percentage are present in the last month before delivery.” 

He added, “Many pregnant women tend to experience breathlessness and swelling of the feet which could be a benign change associated with pregnancy making it difficult to diagnose early.”

Complications of PPCM

Dr Raghu added, “Complications of PPCM include the formation of blood clots within the heart that can embolise the various arterial systems of the body risk loss of limb, renal failure, brain stroke, etc.” 

Also Read: All About Heart Failure: Expert Debunks Myths About This Condition

Diagnosis Of PPCM

The usual battery of tests performed for the diagnosis of PPCM include:

• Clinical examination to detect heart failure
• ECG changes
• X-ray showing fluid accumulation in the chest
• Echocardiography which shows that the pumping ability of the heart (Ejection Fraction (EF) <45%) 
• Cardiac MRI to confirm the reduced EF

Treatment of PPCM 

Dr Raghu said, “Treatment of PPCM has been to treat heart failure primarily. Most women (50-80%) with PPCM recover the heart function to normal within six months of therapy. These statistics reflect the improvement in the prognosis of PPCM since the early 1970s when reported mortality was 30‑50%.” 

PPCM After Delivery

Dr Raghu said, “For women who develop PPCM before delivery, a multidisciplinary team comprising obstetrics, anaesthesia, and cardiology should individualise patient management, including decisions about the timing and mode of delivery. There is no benefit of early induction of delivery. Physicians usually advise caesarean section for delivery and epidural anaesthesia for safe outcomes for both mother and child. Also, breastfeeding is usually not encouraged if the mother is on medicines for control of heart failure.” 

Management During Pregnancy

Many women who have had PPCM want to become pregnant again. Those who had a persistent dysfunction of the heart even with medicines six months after delivery, have a strong chance of worse outcomes. Dr Raghu highlighted, “Women with a history of PPCM should be counselled about the risks of subsequent pregnancy and should be followed closely throughout pregnancy and until six months postpartum with frequent clinical examinations and serial echocardiograms.” 

Bottomline

Dr Raghu concluded, “Even though great advances in the management of PPCM, a lot of answers are needed. Intensive research is being pursued on what causes the disease, the development of specific drugs targeting these mechanisms, and the responsiveness of PPCM patients to various heart failure medicines.” 

[Disclaimer: The information in this article is shared by a registered healthcare professional and is for informational purposes only. Hence, we advise you to consult your expert for a diagnosis and treatment catered to your needs and medical history.]