Peripartum Cardiomyopathy

Peripartum cardiomyopathy refers to otherwise unexplained heart failure during late pregnancy after an evaluation that excludes known causes of cardiomyopathy that include hypertension, thyrotoxicosis, or valvular heart disease. While the cause of peripartum cardiomyopathy remains unknown, there are a number of risk factors that include gestational hypertension (especially preeclampsia), high parity, and multifetal pregnancy, and there is a predilection for obese black women. Another hypothesis is activation of autoantibodies to cause immune destruction of myocardial tissue targeted in response to fetal antigenic material. Typical chest X-ray findings include impressive cardiomegaly with pulmonary edema, and there is single- to four-chamber dilatation with ventricular dysfunction evident on echocardiography. Treatment of heart failure is the cornerstone of management and vigorous diuresis with furosemide is begun promptly. In its purest form, peripartum cardiomyopathy likely represents idiopathic cardiomyopathy of young adults with at least half of cases caused by inflammatory myocarditis usually from viral infections.