Discoveries in peripartum cardiomyopathy Fett, James D., MD, MPH; Markham, David W., MD
Trends in cardiovascular medicine,
07/2015, Letnik:
25, Številka:
5
Journal Article
Recenzirano
Abstract The past decade has seen remarkable gains for outcomes in peripartum cardiomyopathy (PPCM), one of the leading causes of maternal mortality and morbidity in the USA and many other countries, ...including the high-incidence areas of Haiti and South Africa. This review article emphasizes the importance of continuing the process of increasing awareness of PPCM and presents details of this evolving picture, including important discoveries that point the way to full recovery for almost all PPCM subjects. In addition, new interventions will be highlighted, which may facilitate recovery. Numerous studies have demonstrated that when the diagnosis of PPCM is made with LVEF > 0.30, the probability is that recovery to LVEF ≥ 0.50 will occur in the overwhelming majority of subjects. PPCM patients diagnosed with severely depressed systolic function (LVEF < 0.30) and a remodeled left ventricle with greater dilatation (LVEDd ≥ 60 mm) are least likely to reach the outcome recovery goals. These are the patients with the greatest need for newer interventional strategies.
Briefly, those class I recommendations, level of evidence A, that "should be" applied include the following: 1) unburden her from excess retained fluid with diuretics; 2) if postpartum and she has ...adequate (or elevated) blood pressure, initiate tolerable dosages of ACE inhibitors (ACEIs); and 3) phase in beta-blocker (BB) therapy, again in tolerable dosage, as soon as hemodynamic stability permits. Right now, you should: 1) do what is necessary to support her circulation and unburden her from excess fluid; 2) monitor her heart rhythm while in hospital, and, following discharge, with an external wearable cardiac defibrillator; 3) anticoagulate with heparin followed by warfarin until LVEF rises above 35%; 4) support circulation with LVAD, if needed, as a bridge to either recovery or transplant; and 5) institute tolerable dosages of ACEI + BB when and if able, as described in Scenario 1.
Is it safe to use bromocriptine in the early postpartum period? A number of reports indicate acute myocardial infarction has complicated the use of bromocriptine in healthy mothers for lactate ...suppression (5).
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