Heart disease poses threat to new moms

On rare occasions, pregnancy can lead to peripartum cardiomyopathy

161029561On rare occasions pregnancy can lead to peripartum cardiomyopathy, a type of pregnancy-related heart failure once called postpartum cardiomyopathy. Women can develop the condition in the last month of pregnancy or within five months of delivering a baby.

For these women, this type of heart failure can be temporary, or can progress to severe, life-threatening heart failure that requires a heart device to support their weakened heart muscle.

While peripartum cardiomyopathy is rare (occurring in 1 of every 2,500 to 4,000 pregnancies which translates to about 1,000 to 1,300 cases in the U.S. each year), some women are at higher risk than others. It is more common among women who are older, African American, carrying multiples, or who have high blood pressure or preeclampsia.

The cause of peripartum cardiomyopathy is not well understood, but active research is underway to learn more. Early diagnosis improves women’s outlook for recovery.

Knowing what’s normal

Peripartum cardiomyopathy can be difficult to diagnose because some of the symptoms of heart failure are similar to those experienced during the third trimester of pregnancy — shortness of breath, leg swelling, fatigue, fluid retention and weight gain.

That’s because when the heart doesn’t pump well, fluid can build up in the lungs causing shortness of breath and in the legs causing swelling.

How a doctor can help

Davis in clinicWith an echocardiogram a doctor can check for diminished functioning in the heart and measure the percentage of blood that leaves the heart each time it beats, called ejection fraction.

With a few exceptions, peripartum cardiomyopathy is treated with similar medications used for heart failure. A range of medications is available, but women need to consult with their doctor about whether they are safe during pregnancy and compatible with breastfeeding.

Diuretics can relieve fluid retention. Beta-blockers and ACE inhibitors can also help the heart beat more efficiently, but ACE inhibitors cannot be used until after pregnancy.

Any woman who has had a peripartum cardiomyopathy diagnosis should consult with a physician to discuss potential risks prior to having another pregnancy. Also women who have had peripartum cardiomyopathy should work with a cardiologist on long-term monitoring of their heart function.

Take the next steps:

Davis_melinda1Dr. Melinda Davis is a cardiologist in the Women’s Heart Program at the University of Michigan. She has an interest in addressing the needs of pregnant women or those considering pregnancy and has specialty training in managing cardiac complications during pregnancy.