ICU · Obstetric critical care

Peripartum Cardiomyopathy

Also known as Peripartum cardiomyopathy · PPCM · Pregnancy-associated cardiomyopathy · Bromocriptine · Postpartum heart failure

Peripartum cardiomyopathy (PPCM) is idiopathic left ventricular systolic dysfunction (LVEF below 45 percent) presenting in the last month of pregnancy to five months postpartum, in a woman with no pre-existing cardiac disease and no other identifiable cause. Risk factors cluster around multiparity, age over 30, pre-eclampsia (the strongest reversible association), and African descent. Heart-failure symptoms overlap with normal pregnancy, so diagnosis is delayed; a raised BNP plus echocardiography make the call. Management is guideline-directed heart-failure therapy, pregnancy-adjusted: beta-blocker, loop diuretic, and hydralazine or isosorbide dinitrate in pregnancy (ACE inhibitors, ARBs, ARNI and spironolactone are stopped), switching to full GDMT postpartum; anticoagulate the low-ejection-fraction patient, and consider bromocriptine (prolactin blockade). Most women recover (72 percent of the IPAC cohort reached LVEF 50 percent or above by one year); a subsequent pregnancy carries several-fold higher maternal mortality unless the ejection fraction has recovered.