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Query: EC:3.4.15.1 (ACE)
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Peripartum cardiomyopathy is a rare, potentially life-threatening cardiomyopathy of unknown cause. Diagnosis includes clinical (development of cardiac failure in the last month of pregnancy or within 5 months after delivery, absence of an identifiable cause of cardiac failure and absence of recognizable heart disease prior to the last month of pregnancy) and echographic (left ventricular systolic dysfunction) criteria. Therapy is standard, except for angiotensin converting enzyme inhibitors, which should be avoided at the end of pregnancy, and heart transplantation if medical treatment fails. We report the case of a 24 year-old woman who required left ventricular assistance as a bridge before cardiac transplantation.
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PMID:[Peripartum cardiomyopathy]. 1172 86

Peripartum cardiomyopathy is a rare and life-threatening disease of unknown etiology. This diagnosis should be limited to previously healthy women who present with congestive heart failure (CHF) and decreased left ventricular systolic function in the last month of pregnancy or within 5 months after delivery. The diagnosis is not made in the presence of other causes of cardiac dysfunction. Patients who fail to demonstrate improvement within 2 weeks after the onset of symptoms should be evaluated for myocarditis. The type and duration of heart failure treatment is determined by the patient's heart performance at rest and with exertion. Those with normal left ventricular function at rest and with exercise or dobutamine have a good prognosis, and their medical therapy can be tapered off or discontinued over a period of 6-12 months. Patients with normal ventricular function at rest, but abnormal response to exercise should be treated for long periods of time with angiotensin converting enzyme (ACE) inhibitors or beta-blockers. Patients who continue to have depressed LV function have a poor prognosis and require treatment with appropriate medications for the rest of their lives. Pharmacological treatment includes ACE inhibitors, beta-blocking agents, diuretics, digoxin, and anticoagulation. Angiotensin converting enzyme inhibitors are used only after delivery because of their teratogenic effects. Patients who fail to recover may require inotropic therapy, intra-aortic balloon pump and left ventricular assist device as needed. Cardiac transplantation should be considered for patients who fail therapy.
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PMID:Peripartum cardiomyopathy. 1265 59

The incidence of congestive heart failure in the US population is increasing as more women and men survive with chronic hypertensive and atherosclerotic heart disease. Almost half the patients in the US with heart failure are women. Hypertension, diabetes mellitus, and cigarette smoking are all more potent risk factors for the development of heart failure in women than in men. Important differences in presentation and mortality explain gender differences in the clinical course of heart failure. Overall mortality is lower for women than for men with symptomatic heart failure. Some but not all of this difference can be explained by a lower rate of ischemic heart disease. Standard treatments for congestive heart failure, including angiotensin converting enzyme inhibitors and beta-blockers, have been shown to be equally efficacious in men and in women. Preliminary data on angiotensin II receptor blockers suggests equivalent benefit with further trial data awaited. Peripartum cardiomyopathy is a form of heart failure unique to women, occurring in the last stages of pregnancy or within 5 months after delivery. Approximately half of affected women regain normal ventricular function but for those who do not, the risk of recurrent symptomatic heart failure and mortality during subsequent pregnancies is high.
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PMID:Heart failure in women. 1458 Mar 3

Peripartum cardiomyopathy (PPCMP) is a dilated and hypokinetic cardiomyopathy occurring during pregnancy or after delivery, with an estimated incidence between 1/1000 and 1/4000 births. It has been defined as a new onset of heart failure in the month preceding or following delivery, without demonstrated aetiology nor previously known heart disease, and with echocardiographic evidences of left ventricular (LV) dysfunction (LV ejection fraction<0.45). It's a multifactorial disease, immunologic, hormonal, and possibly viral mechanisms playing a determinant pathophysiological role. The classical clinical presentation is a rapid and unexpected onset of heart failure in a previously healthy woman, echocardiography being the key examination for positive and differential diagnosis, prognostication, therapeutic decision-making, and follow-up. The potential severity of PPCMP, and its unpredictable evolution in the first days following diagnosis, require that patients be referred to a tertiary care centre with a high skill in intensive cardiology care. Therapeutic management of PPCMP does not offer any specificity when compared to other causes of acute or chronic heart failure (from diuretics to extracorporeal life support), except for ACE-inhibitors, that are contraindicated before delivery. The high incidence of thrombo-embolic complications observed in the disease requires however rapid and curative anticoagulation, and immuno-suppressive treatment has been proposed in fulminant and highly inflammatory presentation, but its efficacy remains controversial. Very recently, promising results have been reported with bromocriptin-a prolactin secretion inhibitor-for reducing 6-month morbidity and mortality, but these findings have to be confirmed in larger scale randomised trials. As for the long-term evolution, approximately half of the patients will heal, while half of the women will keep some degree of LV dysfunction, 25% of them developing moderate to severe chronic heart failure.
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PMID:[Peripartum cardiomyopathy: A multiple entity]. 2255 97

Peripartum cardiomyopathy (PPCM) is a rare but potentially devastating complication of pregnancy associated with heart failure due to left ventricular systolic dysfunction occurring within the last month of pregnancy and five month postpartum with no obvious other cause of heart failure and no pre-existing heart disease. In the present case report the authors present a woman who developed PPCM on the day after she delivered by cesarean section in 35th weeks of gestation of triplet pregnancy conceived after ovarian stimulation and insemination. A treatment with diuretics, ACE inhibitors, antiarrhythmics, low weight heparin, antibiotics and bromocriptine was applied and resulted in complete recovery. In conclusion, timely detection and initiation of treatment are important factors for complete recovery of patients with PPCM.
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PMID:Peripartum cardiomyopathy: a case of patient with triplet pregnancy. 2713 28