Peripartum Cardiomyopathy

40 y/o G5P4004 at 40 WGA with h/o HTN presents with acute on chronic dyspnea, fatigue. Current pregnancy complicated by pre-eclampsia. Tachycardia, edema on exam.

• Obtain CBC, CMP, urine protein/creatinine, LDH, uric acid

• EKG shows sinus tachycardia

• Echo shows LV dilation/systolic dysfunction and pulmonary hypertension

• Treatment

  • Avoid ACE/ARB, atenolol

  • Consider HCTZ 25mg qd, metoprolol 12.5mg

  • Hydralazine 10mg for hypertensive emergency in pregnancy; see preeclampsia with severe features

  • Titrate diuretics to avoid hypotension, reduced uterine perfusion.

  • Pt advised that most women recover LV function after pregnancy but that future pregnancies may not be advisable

Notes

• May develop during 2nd trimester and up to 4 months postpartum

• Prevalence ~1:2,500 live births