Peripartum Cardiomyopathy (PPCM): Dual Case Report and Review of Literatures

Abstract

Introduction:Peripartum cardiomyopathy (PPCM), unexplained heart failure is a rare complication of pregnancy that occurs at the end of pregnancy or early during the postpartum period. PPCM is a diagnosis of exclusion that is made after other possible etiologies have been eliminated. The presentation of PPCM is generally during the early postpartum period where the patient will typically present with heart failure symptoms; these symptoms are often mistaken for being part of the normal puerperal experience. Although there are many risk factors for the development of PPCM, the greatest risk factors include being of African descent, having multiple gestation pregnancies and advanced maternal age. The etiology of PPCM has never been completely understood. However, it has been postulated that it is related to persistent viral antigen exposure. The management guidelines of the patient with PPCM generally follow guidelines for the management of congestive heart failure resulting from other etiologies, with the exception that angiotensin-converting-enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs), contraindicated during pregnancy, because of their teratogenic effects. Case description:We present two cases of peripartum cardiomyopathy (PPCM) with the discussion of management and literature review. Conclusion:Although the prognosis of PPCM is usually favorable, maternal mortality has been reported. Therefore, clinicians must remain vigilant to facilitate timely recognition of the peripartum complication. Serious nonfatal complications including cardiacdysrhythmias, progressive heart failure requiring heart transplantation, and thromboembolic events manifesting as cerebral vascular accidents and peripheral arterial embolism may occur. Early diagnosis and prompt treatment is associated with a decrease in morbidity and mortality associated with PPCM.