Share this Article
Chee KH
Correspondence: Dr Kok-Han Chee, cheekh@um.edu.my
ABSTRACT
Introduction Peripartum cardiomyopathy (PPCM) is an uncommon form of congestive heart failure, affecting obstetric patients around the time of delivery. The epidemiology of PPCM is infrequently reported. This study was undertaken to define the prevalence, presentation and outcome of PPCM among women giving birth in a teaching hospital in Malaysia.
Methods A retrospective case record analysis was conducted on all patients admitted and diagnosed with PPCM at the University Malaya Medical Centre, Kuala Lumpur, Malaysia, from 1 January 2000 to 31 December 2009. All deliveries were undertaken in the same hospital.
Results A total of 12 patients were diagnosed with PPCM during the ten-year study period. The prevalence of PPCM was 2.48 in 100,000 (1 in 40,322) live births. Nine women were diagnosed with PPCM within five months of delivery. Three women had twin pregnancies. There was one death in the group (mortality rate 8.3%). The mean left ventricular ejection fraction at the time of diagnosis was 28.9% ± 8.5% (range 15%–40%). Following the index event, left ventricular function normalised in six of the nine patients (66.7%) who underwent subsequent echocardiography one year later. All patients were treated with standard heart failure therapy. Two patients with normalised left ventricular function had subsequent pregnancies – one pregnancy was terminated at seven weeks and the other patient delivered uneventfully at full term.
Conclusion PPCM is uncommon. The outcome in our series was favourable, with 66.7% of patients with PPCM recovering their left ventricular function. The mortality rate was 8.3%.
Keywords: epidemiology, heart failure, peripartum cardiomyopathy, pregnancy
Singapore Med J 2013; 54-28-31; http://dx.doi.org/10.11622/smedj.2013007
REFERENCES
| 1. Gouley BA, McMillan TM, Bellet S. Idiopathic myocardial degeneration associated with pregnancy and especially the puerperium. Am J Med Sci 1937; 194:185-99. http://dx.doi.org/10.1097/00000441-193708000-00005 | ||||
| 2. Cunningham FG, Pritchard JA, Hankins GD, et al. Peripartum heart failure: idiopathic cardiomyopathy or compounding cardiovascular events? Obstet Gynecol 1986; 67:157-68. http://dx.doi.org/10.1097/00006250-198602000-00002 | ||||
| 3. Desai D, Moodley J, Naidoo D. Peripartum cardiomyopathy: experiences at King Edward VIII Hospital, Durban, South Africa and a review of the literature. Trop Doct 1995; 25:118-23. | ||||
| 4. Chee KH, Azman W. Prevalence and outcome of peripartum cardiomyopathy in Malaysia. Int J Clin Pract 2009; 63:722-5. http://dx.doi.org/10.1111/j.1742-1241.2007.01449.x | ||||
| 5. Demakis JG, Rahimtoola SH. Peripartum cardiomyopathy. Circulation 1971; 44:964-8. http://dx.doi.org/10.1161/01.CIR.44.5.964 | ||||
| 6. Pearson GD, Veille JC, Rahimtoola S, et al. Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review. http://dx.doi.org/10.1001/jama.283.9.1183 | ||||
| 7. Safirstein JG, Ro AS, Grandhi S, et al. Predictors of left ventricular recovery in a cohort of peripartum cardiomyopathy patients recruited via the internet. Int J Cardiol 2012; 154:27-31. http://dx.doi.org/10.1016/j.ijcard.2010.08.065 | ||||
| 8. Elkayam U, Tummala PP, Rao K, et al. Maternal and fetal outcomes of subsequent pregnancies in women with peripartum cardiomyopathy. N Engl J Med 2001; 344:1567-71. http://dx.doi.org/10.1056/NEJM200105243442101 | ||||
| 9. Fett JD, Fristoe KL, Welsh SN. Risk of heart failure relapse in subsequent pregnancy among peripartum cardiomyopathy mothers. Int J Gynaecol Obstet 2010; 109:34-6. http://dx.doi.org/10.1016/j.ijgo.2009.10.011 | ||||
| 10. O'Connell JB, Costanzo-Nordin MR, Subramanian R, et al. Peripartum cardiomyopathy: clinical, hemodynamic, histologic and prognostic characteristics. J Am Coll Cardiol 1986; 8:52-6. http://dx.doi.org/10.1016/S0735-1097(86)80091-2 | ||||
| 11. Lampert MB, Lang RM. Peripartum cardiomyopathy. Am Heart J 1995; 130:860-70. http://dx.doi.org/10.1016/0002-8703(95)90089-6 | ||||
| 12. World Health Organization. ICD-10 Classifications of Mental and Behavioural Disorder: Clinical Descriptions and Diagnostic Guidelines. Geneva: WHO, 1992. | ||||
| 13. Whitehead SJ, Berg CJ, Chang J. Pregnancy-related mortality due to cardiomyopathy: United States, 1991-1997. Obstet Gynecol 2003; 102:1326-31. http://dx.doi.org/10.1016/j.obstetgynecol.2003.08.009 | ||||
| 14. Fett JD. Peripartum cardiomyopathy. Insights from Haiti regarding a disease of unknown etiology. Minn Med 2002; 85:46-8. | ||||
| 15. Pandit V, Shetty S, Kumar A, Sagir A. Incidence and outcome of peripartum cardiomyopathy from a tertiary hospital in South India. Trop Doct 2009; 39:168-9. http://dx.doi.org/10.1258/td.2008.080353 | ||||
| 16. Yamac H, Bultmann I, Sliwa K, Hilfiker-Kleiner D. Prolactin: a new therapeutic target in peripartum cardiomyopathy. Heart 2010; 96:1352-7. http://dx.doi.org/10.1136/hrt.2009.179218 | ||||
| 17. Habedank D, Kühnle Y, Elgeti T, et al. Recovery from peripartum cardiomyopathy after treatment with bromocriptine. Eur J Heart Fail 2008; 10:1149-51. http://dx.doi.org/10.1016/j.ejheart.2008.09.001 | ||||
| 18. Jahns BG, Stein W, Hilfiker-Kleiner D, Pieske B, Emons G. Peripartum cardiomyopathy--a new treatment option by inhibition of prolactin secretion. Am J Obstet Gynecol 2008; 199:e5-6. http://dx.doi.org/10.1016/j.ajog.2008.06.051 | ||||
| 19. Iffy L, O'Donnell J, Correia J, Hopp L. Severe cardiac dysrhythmia in patients using bromocriptine postpartum. Am J Ther 1998; 5:111-5. http://dx.doi.org/10.1097/00045391-199803000-00010 | ||||
| 20. Fett JD. Caution in the use of bromocriptine in peripartum cardiomyopathy. J Am Coll Cardiol 2008; 51:2083; author reply 2021. http://dx.doi.org/10.1016/j.jacc.2008.02.054 | ||||
| 21. Hopp L, Weisse AB, Iffy L. Acute myocardial infarction in a healthy mother using bromocriptine for milk suppression. Can J Cardiol 1996; 12:415-8. | ||||