Peripartum Cardiomyopathy

Peripartum cardiomyopathy (PPCM) is a rare, life-threatening form of heart failure that affects pregnant women or women who have just given birth. It affects about 1,000 to 1,300 women in the United States each year, according to the American Heart Association.

“It is one of the officially recognized rare diseases in the U.S.,” says Ravi Ramani, a cardiologist and director of the UPMC Integrated Heart Failure Program.

PPCM more commonly is found in developing countries, but the incidence is rising in the United States. Recent estimates put cases of PPCM at 1 in 2,230 births in the United States, and 1 in 1,000 births worldwide.

What Is Peripartum Cardiomyopathy?

PPCM occurs when the function of the left ventricle is disrupted. The ventricle ejects a lower percentage of blood when the heart contracts, which leads to less blood flow. This then causes the body’s other organs to receive less oxygen.

Most cases of PPCM are diagnosed in the late third trimester or up to five months after delivery.

Outcomes vary widely, from a return to normal function to sudden heart failure and death. Patients may need a ventricular assist device or heart transplant.

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Who Is at Risk of Peripartum Cardiomyopathy?

The cause of PPCM is unknown and under investigation. However, several factors can put women at greater risk:

  • Age: Women over the age of 30 are more likely to develop PPCM.
  • Race: Black women show a higher rate of PPCM.
  • Multiple gestations: Rates of PPCM are higher in pregnancies with multiple births.
  • Other pregnancy conditions: Preeclampsia and hypertension put women at greater risk for PPCM.
  • History of heart conditions: People with other heart conditions, such as myocarditis, are at higher risk.
  • Obesity
  • Smoking
  • Alcohol
  • Poor nutrition

What Are the Symptoms of Peripartum Cardiomyopathy?

PPCM symptoms can mirror those of a normal pregnancy. They include:

  • Fatigue
  • Heart palpitations
  • Increased urination at night
  • Shortness of breath
  • Cough
  • Swollen ankles
  • Swollen veins in neck
  • Low blood pressure
  • Irregular heartbeat
  • Coughing up blood
  • Chest and abdominal discomfort

“Those are pretty much symptoms that a lot of women go through during a normal pregnancy,” Dr. Ramani says. “So the diagnosis can be hard in a lot of women. A lot of physicians tend to miss these signs because they overlap significantly with what a normal pregnancy is.”

How Is Peripartum Cardiomyopathy Diagnosed?

Most diagnosis of PPCM takes place after pregnancy – even if the heart failure develops during pregnancy.

Dr. Ramani says the diagnosis takes the patient’s history and the scale of the symptoms into account. If a patient is still showing some of the pregnancy-related symptoms after delivery, that’s one sign of PPCM. The typical diagnostic test is an echocardiogram, which can show decreased function. If no other cause can be found for the heart failure, that leads to a PPCM diagnosis.

“Just because it’s happening at that particular time, doesn’t necessarily mean it’s peripartum cardiomyopathy,” Dr. Ramani says. “It could be something else that just happened and could be coincidental with the pregnancy.”

How Is Peripartum Cardiomyopathy Treated?

The treatment for PPCM depends on the severity of the condition.

Typically, the first course of treatment is with medication, to see if the patient’s heart improves. Medications include:

Doctors must be careful what they prescribe, Dr. Ramani says. Some medications can harm the unborn baby or cause problems for women who are breastfeeding.

If medication doesn’t help the heart to return to normal function, more treatment is required. That can include a ventricular assist device, or in the most severe cases, a heart transplant. About 5 percent of heart transplants for women in the United States are for peripartum cardiomyopathy, according to Obstetrics and Gynecology.

UPMC’s Heart and Vascular Institute and UPMC Magee-Women’s Hospital’s Department of Maternal Fetal Medicine work together on high-risk cardiovascular pregnancies and births. That includes PPTM. The two departments co-manage the health of the mother and child from diagnosis through treatment.

The Heart and Vascular Institute at UPMC Presbyterian Shadyside ranks among the best hospitals in the U.S. for heart care and surgery, according to U.S. News and World Report.

About Heart and Vascular Institute

The UPMC Heart and Vascular Institute ranks among the best in the United States for complete cardiovascular care. U.S. News & World Report lists UPMC Presbyterian Shadyside as one of the top hospitals nationally for cardiology and heart surgery. We treat all manners of heart and vein conditions, from the common to the most complex. We are creating new medical devices and cutting-edge treatments that may not be available at other hospitals. We also offer screenings, free clinics, and education events in the community.