It is important for clinicians to be alert to the
possibility of subclinical, latent, or incubating peripartum cardiomyopathy
(PPCM). Numerous reports have
substantiated that early diagnosis and subsequent treatment may result in
reduced morbidity and mortality.
For this reason we have become very sensitive to the early symptoms of
heart failure in women during their last month of pregnancy and within 5 months
postpartum. We teach all
peripartum women to come to the clinics and hospitals if they have these signs
that could be associated with left ventricular dysfunction:
dyspnea on exertion or shortness of breath at rest,
cough that fails to clear,
and increasing swelling of the legs,
4) Inability to
lie flat to sleep, and/or sudden awakening at night with shortness of breath,
symptoms including palpitations (irregular pulse) and feeling of faintness or
These are all symptoms that merit medical consultation
and consideration for doing an echocardiogram, the definitive test that can
identify a dilated cardiomyopathy.
Medical history and physical exam alone may not alert the clinician to
early left ventricular systolic dysfunction.
is no clear correlation between mild left ventricular systolic function
impairment and clinical symptoms.
Noticeable dyspnea on exertion or at rest varies considerably from
patient to patient with similar mild reductions in left ventricular ejection
fraction. Therefore, it is
understandable that the diagnosis of PPCM may be delayed or even totally missed
unless there is a high level of suspicion, and additional assessments are
are at least two blood tests may help in early detection of left ventricular
Natriuretic Peptide (BNP), indicating left ventricular stress, and
sensitivity C-Reactive Protein (hs-CRP or CRP) associated with an inflammatory
cardiomyopathy, which is often found with PPCM.
addition, many medical centers now have available an imaging tool to help
confirm this: Cardiac magnetic
resonance imaging (CMR), with gadolinium enhancement.
Why does this process lead to heart failure? Gradual loss of functioning
cardiomyocytes exceeding a critical mass leads to left ventricular dilatation
and left ventricular systolic dysfunction. Time interval between the initiation of this process and the
development of clinically detectable heart failure is variable and unknown. The interval may be timed in
hours, days, weeks or months.
An increased sensitivity to the possibility that this type of heart
failure could affect young mothers with a previously healthy heart will help to
assure both survival and full recovery.
James D. Fett, MD
8 January 2012