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Peripartum Cardiomyopathy: A Rare Heart Condition in Pregnant Women

When you become pregnant, your body undergoes lots of changes. While some of these changes are visible, like your growing belly and breasts and swollen ankles, there are lots of changes going on inside your body, like with your heart.

Your heart also rises to the occasion – pumping more blood to your uterus and increasing your heart rate and breathing as needed. During the first trimester, your heart rate can increase by 10 to 15 beats per minute. By the time you’re ready to deliver, your uterus alone is receiving one-fifth of your pre-pregnancy supply of blood.

In rare cases, however, pregnancy can put a strain on your heart causing a life-threatening heart condition called peripartum cardiomyopathy. The symptoms of peripartum cardiomyopathy are similar to those experienced during pregnancy, so symptoms may go undiagnosed.

Read on to learn more about this potentially fatal heart disorder.

What is peripartum cardiomyopathy?

Peripartum cardiomyopathy (PPCM) is a specific type of heart failure that affects women during pregnancy, often the third trimester, or up to several months after giving birth.

“In women with peripartum cardiomyopathy, the heart muscle becomes weak and often enlarged, specifically during pregnancy or up to 6 months after delivery,” said Rebecca Lolley, MD, a cardiologist with Banner Health in Colorado. “When your heart muscle is weak, it can be hard to pump vital oxygen and nutrients to organs in your body. This can lead to the symptoms of heart failure, and in some cases, even death.”

What causes peripartum cardiomyopathy?

Unlike many other cardiomyopathies, there is still no known direct cause of PPCM, but Dr. Lolley said hemodynamic changes associated with pregnancy (increased blood volume and cardiac output) in combination with hormonal, vascular and genetic factors may play a role.

“There are several risk factors that can contribute to its development, specifically older maternal age (women over the age of 30 years old), multiple pregnancies, Black or African American descent, a history of chronic or gestational hypertension, or especially preeclampsia during or after pregnancy,” she said.

What are the symptoms of peripartum cardiomyopathy?

One reason PPCM can be so scary is that many symptoms overlap with normal pregnancy symptoms, so diagnosis is often delayed.

“Women should monitor for signs of hypertension, excessive fluid buildup in their legs (edema) or significant increases in shortness of breath, which may be a sign that fluid is building up in their lungs,” Dr. Lolley noted.

In addition, women may experience increased fatigue and low blood pressure. These symptoms can be hard to pinpoint, but if you believe what you’re feeling isn’t normal, don’t hesitate to talk to your health care provider.

Often PPCM can be diagnosed during a routine pregnancy or postpartum exam, or after delivery when symptoms can become more obvious and severe.

How is peripartum cardiomyopathy treated?

PPCM is largely treated like any other form of heart failure, by relieving symptoms with diuretics and medications to help the heart recover and get stronger.

Commonly used medications include:

  • Beta-blockers
  • ACE (angiotensin-converting enzyme) inhibitors
  • Hydralazine/nitrates
  • Aldosterone inhibitors
  • Diuretics

“ACE inhibitors and aldosterone inhibitors can’t be used during pregnancy, but enalapril and captopril (ACE-inhibitors) and spironolactone (aldosterone inhibitor) are safe to use with breastfeeding and should be started in addition to beta-blockers after delivery,” Dr. Lolley said.

In severe cases of PPCM, a woman may need surgery or a heart transplant.

Can women recover from peripartum cardiomyopathy?

PPCM does have a higher rate of recovery than other forms of heart failure. If you continue to take medications as recommended—even after recovery—you may have a very good chance of recovering. However, you may be at an increased risk for PPCM reoccurring if you decide to get pregnant again.

Women with recovery can safely get pregnant again.  However, “This will require close monitoring throughout the pregnancy by both the woman’s OBGYN and cardiologist, including clinical assessments, ultrasounds of the heart and lab work,” Dr. Lolley said. “Women should keep in mind that they will need to stay on their heart failure medication (primarily beta-blockers and diuretics which are safe in pregnancy) as well as have a cardio-obstetrics team on board for safe delivery planning.”

If you don’t make a full recovery, subsequent pregnancies are strongly discouraged, as it can result in a 50 percent risk of further decline in your heart function as well as an increased risk of maternal death.

Can I prevent peripartum cardiomyopathy?

Since the cause for PPCM is often unknown, it may not be preventable. There are things you can do, however, to reduce your risk, such as:

  • Stay active and eat a well-balanced diet
  • Don’t smoke or use illicit drugs
  • Avoid alcohol
  • Keep your blood pressure and cholesterol in check

[Read “5 Tips for Having a Happy and Healthy Pregnancy”]

Takeaway

The symptoms of PPCM can resemble those of normal pregnancy, so talk to your health care provider about any concerns that appear abnormal for you. Treated early and aggressively, PPCM can have great outcomes.

If you have questions or concerns, contact your health care provider or find a Banner Health specialist near you at bannerhealth.com.

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Heart Health Women's Health Pregnancy

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