Hemodynamic studies may reveal tachycardia, elevated pulmonary artery and wedge pressure, and decreased stroke volume. Although the cause of the disorder is unknown, many believe that there may be some previously undiagnosed heart disease that is exacerbated by the hemodynamic changes of pregnancy.7 Several maternal complications of pregnancy such as preeclampsia, anemia, multifetal gestation, and diabetes have been implicated in increasing the incidence of the disorder. It is therefore necessary to appropriately diagnose this condition and to distinguish this from similar cardiomyopathic conditions such as idiopathic dilated cardiomyopathy. In the past, few therapeutic modalities appeared to be helpful. Transplantation itself was related to a significant amount of morbidity, with both early and late rejection, as well as infection requiring cytolytic therapy occurring more frequently in patients with peripartum cardiomyopathy than in patients with other cardiomyopathies.
Medical therapy depends on early identification of potential causes.
The treatment of cardiomyopathy due to myocarditis is significantly different from the treatment of cardiomyopathy caused by ischemia. Dilated cardiomyopathy may be idiopathic, viral, inflammatory, alcoholic, uremic, or rheumatologic or may be due to hemochromatosis. Cardiomyopathy due to valvular heart disease must be identified or ruled out early, since the commonly prescribed supportive therapy may be detrimental in this condition. Acute medical therapy involves reducing preload and afterload with diuretics, nitroglycerin, or nitroprusside, and maintaining inotropic support with dobutamine, dopamine, norepinephrine, and amrinone. Central hemodynamic monitoring is recommended.