English

Abstract

Peripartum cardiomyopathy (PPCM) is a form of dilated cardiomyopathy of unclear etiology, affecting women without pre-existing cardiac diseases, during the last month of pregnancy or up to five postpartum months 1 As with other form of dilated cardiomyopathies, PPCM involves the systolic dysfunction of the heart with a decrease in Left Ventricular Ejection Fraction (LVEF) <40, associated with congestive heart failure and with an increased risk of supra ventricular or ventricular arrhythmias, thromboembolism and even sudden cardiac death. PPCM is diagnosed by exclusion, where the patient has no history of previous heart disease, coincides with the pregnancy period (one month pre-operative to five months post- operative), and where no other possible cause of heart failure present. Diagnosis of Peripartum cardiomyopathy is a dilemma for the obstetricians, physicians, cardiologists, and the general physicians, as most of these patients are hurriedly diagnosed and treated first as a case of Left Ventricular Failure (LVF) of some cardiac origin. Specific treatment is started late or not at all. So, relapses are very common with the treatment line of Left Ventricular Failure of cardiac origin only without any specific treatment and no precautions taken, thereafter. Although the exact cause of PPCM is unknown, yet (a) some cardio tropic virus (b) immune system dysfunction8, (c) genetic factors 1, (d) deficiency of micro-nutrients or trace elements (e) some cardio-toxins may serve as a trigger to malfunction of immune system that may be responsible in the development of PPCM. Recently two cases of PPCM were transferred to our ICU from the obstetrics and gynecology department immediately after deliveries for acute left ventricular failure in quick succession and were diagnosed as PPCM and successfully managed with Diuretic, ACE inhibitor, Beta blocker and Nitrates with mechanical ventilation. After discharge from the hospital they are being followed up and are put on Hydralazine with ACE inhibitor and beta blocker since last three months and they are reported doing well.