Peripartum cardiomyopathy :a proposed clinical pathway for early diagnosis -

Abstract

Peripartum cardiomyopathy (PPCM) is a rare but devastating disease that hits women at a time when heart disease should not be a concern. PPCM is a type of idiopathic, non-ischemic, dilated cardiomyopathy presenting with symptoms of heart failure primarily due to left ventricular (LV) systolic dysfunction that is manifested in the last trimester of pregnancy and up to 5 to 6 months after delivery. It is clear from the literature that women from black or Haitian descent are the most prone to having the condition. In Lebanon, no studies are conducted on the disorder in general. The clinical presentation can be either sudden requiring urgent admission to the intensive care unit, progressive or latent. The etiopathogeneis is still unknown but thought to be multifactorial. Signs and symptoms are similar to those in acute heart failure. The diagnosis is a diagnosis of exclusion, after ruling out cardiac-pregnancy related conditions. Echocardiography is the gold standard tool for diagnosis and cardiac magnetic resonance can be added as a complementary in critical unresponsive cases. Treatment is similar to that of conventional heart failure with consideration of contraindicated drugs in pregnancy and lactation. Novel drugs and biomarkers are promising but still in the early stages and more studies are still required to finalize and generalize their bedside uses. Since early diagnosis is the key to early recovery with less complication and preservation of ejection fraction, I shed the light on screening and risk stratification. Therefore, I created a detailed clinical pathway for early diagnosis, risk factors, differential diagnosis, complications, and management. This will help health care providers to detect the disease early enough to avoid devastating outcomes.