What is Peripartum and Postpartum Cardiomyopathy?
Peripartum and Postpartum Cardiomyopathy (KAR-de-o-mi-OP-ah-thee) (PPCM) is a form of dilated cardiomyopathy. It is a deterioration in cardiac function, presenting typically between the last month of pregnancy(peripartum) and up to five months after pregnancy (postpartum).
PPCM involves systolic dysfunction of the heart with a decrease of the left ventricular ejection fraction (EF) with associated congestive heart failure and an increased risk of atrial and ventricular arrhythmias, thromboembolism (blockage of a blood vessel by a blood clot), and even sudden cardiac death. In essence, the heart muscle cannot contract forcefully enough to pump adequate amounts of blood for the needs of the body’s vital organs.
PPCM is a diagnosis of exclusion, wherein patients have no prior history of heart disease, and there are no other known possible causes of heart failure.
The cause of PPCM is unknown. Researchers are investigating cardiotropic viruses, autoimmunity, or immune system dysfunction. Other toxins that serve as triggers to immune system dysfunction, micronutrient or trace mineral deficiencies, and genetics as possible components that contribute to or cause the development of PPCM.
The process of PPCM begins with an unknown trigger (possibly a cardiotropic virus or other yet unidentified catalyst) that initiates an inflammatory process in the heart. Consequently, heart muscle cells are damaged; some die or become scar tissue. Scar tissue cannot contract; therefore, the effectiveness of the pumping action of the heart decreased. Also, damage to the cytoskeletal framework of the heart causes the heart to enlarge, stretch, or alter in shape, reducing the heart’s systolic function or output. The initial inflammatory process appears to create an autoimmune or immune dysfunctional process, which in turn fuels the initial inflammatory process. The progressive loss of heart muscle cells leads to eventual heart failure.
Unfortunately, patients and clinicians sometimes dismiss early symptoms because they appear to be typical of a healthy pregnancy. Yet, early detection and treatment are critically important to the patient with PPCM. Delays in the diagnosis and treatment of PPCM are associated with increased morbidity and mortality.