PPCM General Information

Peripartum cardiomyopathy (PPCM) is a form of heart failure that typically happens during the last month of pregnancy or up to five months after giving birth. This condition weakens the heart muscle and causes the heart to become enlarged. As a result, the heart can’t pump blood properly to the rest of the body. Early detection and correct medical management of the condition results in a much higher success rate of recovery. PPCM is one of the leading causes of maternal death. It is not a common condition but it is also not rare. PPCM can occur in any woman of any racial background, at any age during reproductive years, and in any pregnancy. 

Chest pain

Cough  

Shortness of breath upon exertion or when lying down 

Difficulty breathing 

Feeling of heart racing or skipping beats (palpitations) 

Swelling of the legs, feet, and ankles 

Excessive fatigue and weakness 

Swelling of abdomen 

Increased nighttime urination  

Lack of appetite or nausea  

PPCM may be difficult to detect because symptoms of heart failure can mimic those of third trimester pregnancy, such as swelling in the feet and legs, and some shortness of breath. More extreme cases feature severe shortness of breath and prolonged swelling after delivery.   

Different tests can be performed to determine diagnosis.  

1.   Chest X-Ray

2.   Electrocardiogram (EKG) 

3.   Bloodwork to look at liver, kidney, thyroid function, as well as electrolytes levels such as sodium and potassium. 

4.   Blood test: BNP blood test. This test measures the level of protein called BNP that is made by your heart and blood vessels. BNP levels are higher than normal when you have heart failure. 

5.  Echocardiogram: this is an ultrasound of the heart that determines if the heart is enlarged. This test will determine the ejection fraction, (EF) which is how much blood your heart is pumping with each heartbeat. Less than 45% EF would be considered early stages of heart failure. A normal range is 55-70% EF.    

PPCM is diagnosed when the following three criteria are met:  

1.   Heart failure develops in the last month of pregnancy or within 5 months of delivery. 

2.   Heart pumping function is reduced, with an ejection fraction (EF) less than 45% (typically measured by an echocardiogram).  

3.   No other cause for heart failure with reduced EF can be found.     

The objective of PPCM treatment is to keep extra fluid from collecting in the lungs and to help the heart recover as fully as possible. Many women recover normal heart function or stabilize on medicines. Some progress to severe heart failure requiring mechanical support or heart transplantation.   

Typical medical treatment includes standard high blood pressure drugs such as ace inhibitors and beta blockers and a diuretic (to remove excess water from the body).  These drugs stop the immune dysfunction and give the heart a rest, so it is able to heal. However, modifications to standard therapy are often necessary to ensure the safety of the mother and the unborn or breastfeeding child.     

Not sure if what you are experiencing is PPCM heart failure? Take this self-test based on questions by PPCM expert cardiologist Dr. James Fett. 

Click on the link below for the self-test and recommended course of action.