Postpartum cardiomyopathy, which is also called peripartum cardiomyopathy (PPCM), is a rare form of heart failure. It occurs in the last month of pregnancy or up to 5 months after delivery. It is a type of congestive heart failure, which causes your heart to become larger than normal and weak. This decreases the amount of blood that your heart can pump.
Because your heart can't pump as much blood, it can't get enough oxygen to your organs. This affects your liver, lungs, and other systems. PPCM is rare in the United States. It only occurs in the US between 1 in 1000 and 1 in 4000 pregnancies every year.
What Causes Postpartum Cardiomyopathy?
No one is sure what causes postpartum cardiomyopathy. Studies of the heart muscle of women who had PPCM have shown inflammation (swelling or redness). This could be because of a previous viral illness or because of an abnormal immune system response. It might also be caused by poor nutrition, genetics, a heart spasm, or damage to the small arteries in the heart.
Who Is at Risk for Postpartum Cardiomyopathy?
While no one knows exactly what causes PPCM, several factors increase your risk of developing it. The risk of developing PPCM is higher the more risk factors you have, including being:
- Over the age of 30
- African American
- Pregnant with multiple babies at the same time
Other risk factors that increase your risk for developing PCCM include a history of the following conditions:
- Preeclampsia or eclampsia
- High blood pressure (hypertension)
- Anemia
- Substance abuse
- Autoimmune diseases such as lupus
- Asthma
What Are the Symptoms of Postpartum Cardiomyopathy?
Symptoms of PPCM are similar to symptoms of other types of heart failure, including:
- Shortness of breath, especially when lying down
- Cough
- Swelling in the lower legs, ankles, and stomach
- Fast heart rate (tachycardia)
- Extreme tiredness
- Swollen neck veins
- Difficulty exercising or being active
Some of these symptoms commonly happen in the later stages of pregnancy. However, with postpartum cardiomyopathy, these symptoms are typically worse than those that normally happen during pregnancy. They may also get worse with time.
How Is Postpartum Cardiomyopathy Diagnosed?
Your doctor will diagnose postpartum cardiomyopathy by ruling out other causes of heart failure. They will listen to your symptoms and do a physical exam. They will also listen to your lungs to see if there is any fluid in them. Your doctor may also do some tests and imaging studies, including:
- Echocardiogram, which is an ultrasound of the heart
- Electrocardiogram (ECG), which records the electrical signals from your heart
- Blood tests
- Magnetic resonance imaging (MRI), which can create a detailed image of your heart
After doing blood tests and imaging studies, your doctor will diagnose you with cardiomyopathy if you meet the following criteria:
- Heart failure that develops in the last month of pregnancy or within 5 months of delivery
- Reduced heart pumping function with an ejection fraction (EF) of less than 45% (Normal EF, which is how much blood the left ventricle pumps out with each contraction, is between 55% and 70%)
- No other cause of heart failure with reduced pumping function is present
How Is Postpartum Cardiomyopathy Treated?
Doctors treat PPCM by trying to keep extra fluid from collecting in your lungs and helping the heart recover. There are several different types of medicines that doctors prescribe to treat PPCM. Some are safer for women who are breastfeeding.
- Angiotensin-converting enzyme (ACE) inhibitors. These medications help your heart work more efficiently.
- Digitalis. This is a medicine that comes from the foxglove plant. It helps strengthen your heart's ability to pump. It's been used for more than 200 years to treat heart failure.
- Beta-blockers. These cause the heart to pump more slowly so it has time to recover.
- Anticoagulants. These are medications that keep your blood from clotting. People with PPCM are more likely to develop blood clots.
- Diuretics. These help your body get rid of extra fluid.
Your doctor may also recommend that you do the following:
- Eat a low-salt diet
- Limit fluids
- Weigh yourself daily, since an unexplained weight gain of 3 or 4 pounds in 1 or 2 days could mean fluid is building up
- Don't smoke
- Don't drink alcohol
What Is the Outlook for Postpartum Cardiomyopathy?
Most women with postpartum cardiomyopathy recover some or all of their heart function. You will need to follow up closely with your doctor. Some women only recover part of their heart function after 6 months or more, but some recover completely within 2 weeks. How severe your PPCM is doesn't seem to affect recovery. Some women with severe symptoms and a low ejection fraction recover completely.
If you want to have more children, you'll need to talk about the risks with your doctor. If you haven't recovered 100% of your heart function, your doctor will likely discourage you from getting pregnant again.
Pregnancy puts a lot of strain on your heart, and you may not be able to handle having another baby. Pregnancy could make your heart failure worse. You may end up needing a heart transplant, or the condition could be fatal.
Even if your heart function is back to normal, you could develop heart failure with another pregnancy. You should consult with a doctor who specializes in high-risk pregnancies and a cardiologist before you get pregnant again.
