Peripartum cardiomyopathy: a clinical review for nurses

Abstract

Peripartum cardiomyopathy is a rare form of heart failure occurring within the last month of pregnancy and in the post-partum period. The pathophysiology is poorly understood and may be multi-factorial. Abnormal prolactin secretion, the presence of myocarditis, an autoimmune component, and nutritional causes are several potential aetiologies. Very little is known about its true prevalence as most data are derived from single-centre case series. The diagnosis is one of exclusion of other causes of symptoms, with echocardiography possessing an integral role in the diagnostic process ( Sliwa et al, 2010 ). Treatment is similar to that of other forms of heart failure, albeit with exclusion of renin–angiotensin–aldosterone inhibition in the pre-partum period. The clinical course is highly variable ranging from full recovery of left ventricular function to refractory heart failure resulting in the need for mechanical support and/or cardiac transplantation. Holistic nursing care involves early recognition of symptoms, haemodynamic instability and evaluation of the therapies administered. Care of the foetus needs to be addressed with foetal monitoring and an established birthing plan. Education regarding selfcare and counselling regarding future pregnancy and family planning is an integral component of nursing care. Follow-up with periodic echocardiography is essential in detecting improvement or persistent left ventricular dysfunction. There is a paucity of data and empirical evidence regarding this condition and the establishment of the EURObservational registry ( Sliwa et al, 2014 ) serves to increase knowledge and awareness of PPCM.