What is peripartum cardiomyopathy?

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PPCM is a rare form of heart failure that develops during late stage pregnancy. A person may also develop PPCM up to 5 months after having their baby.

A person’s heart comprises four chambers:

• the left atrium
• the right atrium
• the left ventricle
• the right ventricle

The atria, which are the heart’s upper chambers, receive blood from the veins. The ventricles, the lower chambers, pump blood out into the body.

PPCM weakens the pumping chambers of the heart. This causes its muscles to become thinner, meaning it cannot contract normally. If the heart cannot contract properly, it cannot pump enough blood around the body.

Learn more about the anatomy of the heart.

PPCM can be difficult to diagnose, as some symptoms are similar to those observable in late pregnancy. Symptoms, such as swelling in the feet and legs and shortness of breath, can be a side effect of pregnancy or a symptom of PPCM.

A doctor will perform a physical exam to check for signs of PPCM. During this exam, they will use a stethoscope to check for:

• fluid in the lungs
• crackling sounds from the lungs
• a rapid heart rate
• unexpected noises from the heart

A doctor may also request an echocardiogram, an ultrasound of the heart. By using an echocardiogram, they can look at the structure of this organ. This helps them check for anything unexpected or heart function issues.

The doctor may also use laboratory tests to check:

• liver, kidney, and thyroid function
• electrolytes, chemicals that regulate nerve and muscle function
• signs of anemia or infection
• for evidence of cardiac injury or stress

Guidelines

According to the AHA, a person will receive a diagnosis of PPCM if they meet the following three criteria:

1. The heart is less able to pump due to left ventricular dysfunction. The left ventricle of the heart is in charge of pumping oxygen-rich blood around a person’s body. If the left ventricle becomes enlarged, it can pump less blood. The amount of blood that the left ventricle pumps is called the ejection fraction (EF), which is typically between 55% and 70%. If a person has PPCM, their EF is less than 45%.
2. Heart failure has developed in the last month of pregnancy or up to 5 months following delivery.
3. There is no other cause for the person’s heart failure.

PPCM treatment aims to prevent fluid buildup in the lungs and help the heart recover. A doctor can prescribe the following medications to treat PPCM:

• angiotensin-converting enzyme inhibitors, which help improve blood flow
• beta-blockers, which lower heart rate
• diuretics, which reduce fluid retention
• digitalis, which strengthens the pumping ability of the heart
• anticoagulants, which help prevent blood clots
• sodium-glucose transport protein 2 inhibitors
• angiotensin receptor blockers
• angiotensin receptor-neprilysin inhibitors

However, some of these medications are not safe for a developing fetus or baby when the parent is nursing, so individuals need to discuss the risks and benefits with a healthcare professional.

Doctors may also recommend lifestyle changes to treat PPCM, such as:

• reducing salt intake
• restricting fluid
• quitting smoking
• stopping alcohol intake

A doctor may also suggest that a person weighs themselves daily. An increase of 3–4 pounds or more over 1–2 days may signal fluid retention.

Symptoms of PPCM can include:

• fatigue
• palpitations, which might feel like the heart is racing or has skipped a beat
• increased nighttime urination
• shortness of breath during activity or when lying flat
• swollen ankles
• swollen neck veins
• low blood pressure
• blood pressure that lowers when standing up
• exercise intolerance

Health experts commonly use the New York Heart Association classification to categorize heart failure symptoms in the following way:

• Class I: Disease with no symptoms
• Class II: Mild symptoms or symptoms with extreme exhaustion
• Class III: Symptoms with minimal exertion
• Class IV: Symptoms during rest

The exact cause of PPCM is currently unclear. The AHA notes that biopsies on people’s hearts with PPCM indicated inflammation, suggesting that an immune response or previous viral infection could be responsible.

The AHA suggests the following as potential causes for PPCM:

• not following a nutritious diet
• small-vessel disease, a condition that affects the small blood vessels of the heart
• coronary artery spasm
• issues with the body’s antioxidant defenses, which help prevent cell damage
• genetics
• pregnancy-related factors such as preeclampsia and hormonal influences on the heart

Certain risk factors may increase a person’s chances of developing PPCM, including:

• having obesity
• a history of heart problems, such as inflammation of the heart muscle
• using certain medications
• smoking
• alcoholism
• having multiple pregnancies
• not following a nutritious diet
• asthma
• preeclampsia
• high blood pressure
• autoimmune disease
• substance misuse
• thyroid dysfunction

Studies have found that people with Black ancestry have a higher chance of developing PPCM. However, this may be due to genetic factors or disparities in the healthcare of Black people.

A study from 2020 found that 50% of PPCM cases occur in women over 30 years of age. However, the condition can affect individuals of varying age groups.

Ethnic and racial disparities

Cardiovascular disease is the leading cause of pregnancy-related deaths, and there are significant ethnic and racial disparities. Black, American Indian, and Alaska Native women are around two to three times more likely to die from pregnancy-related causes than white females.

In 2017, the American College of Cardiology reported data that researchers collected over 30 years. It showed that African American women presented with more severe cases of PPCM than non-African American women. They also recovered less frequently, and when they did recover, it took them twice as long as non-African American women.

A small study from 2019 reported a generally good outlook for people with PPCM. Researchers found that 5 years after treatment for the condition, mortality rate and negative outcome levels were low. However, individuals from the study often developed other cardiovascular conditions such as arrhythmias and high blood pressure. They often also needed long-term medication.

Research from 2021 suggests that 50% of people with PPCM recover with standard treatment. However, the authors note that 25% of individuals with the condition develop chronic heart failure and that PPCM results in death for the remaining 25%.

According to a 2020 article, recovery and mortality rates vary significantly based on racial groups, geographical region, and the definition of recovery.

PPCM can lead to complications such as:

• progression to severe heart failure
• cardiogenic shock
• blood clots
• atypical heart rhythm
• stillbirth
• sudden death

A person who has had PPCM can still have more children. However, doctors may advise them against further pregnancies if their EF remains low or the risk of recurrence is high. The mortality is high for people who have more children while having low EFs.

If an individual with PPCM wishes to have more children, they should discuss the risks and benefits with their cardiologist.

If a person wants to reduce their risk of developing PPCM, they should:

• avoid cigarettes
• avoid alcohol
• eat a well-balanced diet
• get regular exercise
• maintain a moderate weight

An individual may also wish to speak with a doctor about their risk of developing PPCM. A healthcare professional may suggest ways to reduce certain risk factors for the condition.

If a person notices symptoms of PPCM, they should speak with a doctor as soon as possible. PPCM can be fatal, so individuals need swift diagnosis and treatment.

A person should also speak with a healthcare professional if they develop any concerning symptoms during pregnancy.

PPCM is a form of heart failure that develops in late pregnancy or up to 5 months after pregnancy.

Doctors diagnose PPCM when a person has an EF of less than 50% and there is no other cause for heart failure. Once healthcare professionals diagnose PPCM, they can prescribe various medications to treat the condition.

There are certain risk factors for PPCM. A person may reduce their chances of developing the condition with several lifestyle changes.

The outlook for individuals with PPCM is good. However, PPCM can be a fatal condition, so people should undergo treatment as soon as possible.

An individual with PPCM can also consider having more children, although doctors may advise against it.