Heart Failure After Pregnancy: Are You at Risk?

Although rare, peripartum cardiomyopathy can be very a serious health condition in women during the last trimester of their pregnancy and also in the preceding 5 months after the prengancy. Researchers have defined strict diagnostic criteriea for the diagnosis, which includes signs and symptoms of heart failure: shortness of breath, leg swelling, change in exercise tolerance, chest pain and also they will have signs on the ultrasound of the heart (aka echocardiogram), which suggests that the heart is not beating as strongly as it once did. As you can imagine this can be confusing both for the patient and the physician since the symptoms I described are often frequent in pregnanct women and even after they have delivered their baby. Other possible diagnosis (if one does not have the echocardiogram yet) would include a pulmonary embolism, which is a clot that travels from the leg to the lungs, which is also common in pregnant women; an arrthymia (irregular heart beat) is also possible, which could make the heart beat faster and after time, this could also lead to heart failure or even a stroke; finally these symptoms could be due to a heart attack or even an infection around the heart (aka myocarditis).

The cause for peripartum cardiomyopathy remains to be clearly delienated, however, it seems like to be related to a combination of an infectious process and an autoimmune process, meaning that the pregnant patient may have developed an infection, which provoked an immune response that may have led to an attack on the normal heart muscle cells, which are then destroyed either temporarily or indefinetly. There have been attempts to even treat these patients with immunosuppresive medications such as steroids, which seem to help some patients, although this is not the current treatment for this disease.