This issue of Clinical Discussions addresses the diagnosis and treatment of peripartum cardiomyopathy. A variety of risk factors have been associated with the development of cardiomyopathy including preexisting maternal diabetes, sepsis, pregnancy induced hypertension, chronic essential hypertension, tocolytic therapy, and prior history of cardiomyopathy. The mechanism of action for the development of cardiomyopathy obviously is not uniform in all of these clinical circumstances. The common thread among patients with cardiomyopathy is a mild cardiogenic pulmonary edema. The Starling mechanism is invoked as a reason why the patient's cardiac performance has deteriorated.
Most patients have symmetric cardiomegaly, with some degree of right sided enlargement.
In the case of sepsis, bacterial toxins have postulated as a potential causative effect. In some cases such as severe pregnancy-induced hypertension, chronic essential hypertension, and prior cardiomyopathy, underlying maternal cardiac disease may be the contributing factor. The subjective symptoms in most patients with cardiomyopathy are identical to adult patients in pulmonary edema. Patient report tachypnea, tachycardia, orthopnea, and shortness of breath. Exercise tolerance is severely decreased and patients essentially deteriorate to a status of modified bed rest.