What Is PPCM?

PPCM stands for peripartum cardiomyopathy and is also known as postpartum heart failure. Cardiomyopathy means diseases of the heart muscles and peripartum means the period of time shortly before, during, and right after giving birth. PPCM is a form of dilated heart failure and is an uncommon type of heart failure. PPCM can start at the end of pregnancy and up to a year postpartum. 

With PPCM, your heart becomes enlarged and the muscles in your heart weaken. Due to this weakness, there is a decrease in the amount of blood that your heart is able to pump throughout your body. The Left Ventricular Ejection Fraction is the amount of blood that is ejected from the heart with each contraction. With a weakened heart, you will have a decrease in your Ejection Fraction. A normal heart function (Left Ventricular Ejection Fraction) is between 55% to 70%. Anything less than 55% is considered heart failure. With PPCM, the risk of blood clots are very high.

PPCM is often unrecognized and misdiagnosed. It is diagnosed between 1 in every 1,000 to 1 in every 4,000 women. Cardiac conditions are the number one cause of maternal mortality in the United States. Georgia is the worst and ranked at the top for maternal mortality. 

Because PPCM symptoms mimic pregnancy symptoms, it is very easy to miss. PPCM is detected with an echocardiogram. It can also be found earlier with a blood test called BNP (B-type Natriuretic Peptide). 

Some symptoms of PPCM are:​​

• Cough

• Fatigue

• Rapid heart rate

• Lightheadedness

• Heart palpitations

• Swollen neck veins

• Low blood pressure

• Shortness of breath

• Chest pain/tightness

• Swelling in the legs/ankles

• Increased urination at night

• Weight gain from fluid retention

Women with an Ejection Fraction of less than 35% will often have to wear a temporary device called a Life Vest that will shock your heart if you happen to have a cardiac event. Most women will recover within a year as PPCM is reversible. For some women, it will take up to three or more years to fully recover and some will live with heart failure for the rest of their lives. Those that don’t improve over 35% often require an Implantable Cardioverter Defibrillator (ICD) or a Subcutaneous Cardioverter Defibrillator (S-ICD) to be placed as the risk of cardiac death is high if your Ejection Fraction is under 35%. For more extreme cases and with Ejection Fractions under 15%, some women will need a heart transplant or a heart pump (LVAD/Left Ventricular Assist Device). 

Most women are able to improve their heart function with a quad therapy guided medication treatment. This treatment consists of some of the following medications:

• ARBs

• ARNIs

• ACEIs

• Digitalis

• Diuretics

• Beta blockers

• Anticoagulants

• Angiotensin receptors

​At this time, clinical trials are being conducted to see if Bromocriptine would be an effective medication for the recovery of PPCM.

The cause for PPCM is currently not known but some risk factors include: 

• Multiple gestations 

• High blood pressure 

• Hyperemesis gravidarum

• Being over the age of 35

• African American descent 

• Pre-eclampsia/Eclampsia  

     

PPCM is diagnosed when the following conditions are present: ​

• The LVEF is under 55%.

• The heart failure starts at the end of pregnancy or the months after pregnancy. 

• No other cause for heart failure can be found/no pre-existing heart conditions.

When you are diagnosed with PPCM, you will also be advised to follow a low-sodium diet consisting of no more than 2,000 mg of sodium in one day. To prevent fluid retention, most women are also put on fluid restriction which allows for no more than 2 liters of fluid a day. 

Women with PPCM are also encouraged to weigh themselves daily to ensure fluid is not building up. Gaining 3 pounds or more within one day or more than 5 pounds in one week can be a sign of fluid buildup. 

Once you have PPCM, even if you recover, it is highly advised to not have future pregnancies as it will put you back in heart failure and can result in death. 

 

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