PERIPARTUM CARDIOMYOPATHY - AN OMINOUS DIAGNOSIS

OBJECTIVE: Our purpose was to review and characterize the initial pres entation, etiology, and prognosis of peripartum cardiomyopathy. STUDY DESIGN: Cases of peripartum cardiomyopathy confirmed by echocardiograp hy were prospectively collected between 1986 and 1994. RESULTS: A tota l of 28 patients without an antecedent history of heart disease Were d iagnosed with peripartum cardiomyopathy. Common associated disorders i ncluded preeclampsia or chronic hypertension (19), alcohol abuse (2), family history (2), and multiple tocolytic therapy (2). Five deaths oc curred (18% mortality), 3 patients received heart transplants (11%), 1 8 continued with cardiac impairment (64%), and only 2 patients (7%) ha d regression of cardiomyopathy. The perinatal mortality rate was 36 pe r 1000 births. Six patients had seven subsequent pregnancies; 4 patien ts decompensated earlier in the subsequent pregnancy, 1 patient remain ed well compensated on medical therapy in spite of poor systolic funct ion and a dilated left ventricle, and 1 patient had two subsequent pre gnancies without recurrence of cardiac compromise. CONCLUSION: The uni que hemodynamic stresses of pregnancy unmask previously undiagnosed ca rdiomyopathy in otherwise medically stable individuals. The prognosis for these patients is guarded.