Peripartum cardiomyopathy - Revision history

Rossdonaldson1: /* Evaluation */

2024-12-11T21:01:16Z

Evaluation

← Older revision		Revision as of 21:01, 11 December 2024
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	==Evaluation==		==Evaluation==
			[[File:UOTW 14 - Ultrasound of the Week 3.jpg\|thumb\|Cardiac ultrasound of peripartum cardiomyopathy.]]
	===Workup===		===Workup===
	*[[ECG]]		*[[ECG]]

Rossdonaldson1: /* Prognosis */

2022-06-07T22:38:54Z

Prognosis

← Older revision		Revision as of 22:38, 7 June 2022
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	==Prognosis==		==Prognosis==
	*Mortality rate up to 10%<ref>Bhattacharyya A et Al. Peripartum Cardiomyopathy: A Review. Tex Heart Inst J. 2012; 39(1): 8–16.</ref>		*Mortality rate up to 10%<ref name="Peripartum Cardiomyopathy">Bhattacharyya A et Al. Peripartum Cardiomyopathy: A Review. Tex Heart Inst J. 2012; 39(1): 8–16.</ref>
	*High risk of recurrence in subsequent pregnancies<ref>Bhattacharyya A et Al. Peripartum Cardiomyopathy: A Review. Tex Heart Inst J. 2012; 39(1): 8–16.</ref>		*High risk of recurrence in subsequent pregnancies<ref name="Peripartum Cardiomyopathy">Bhattacharyya A et Al. Peripartum Cardiomyopathy: A Review. Tex Heart Inst J. 2012; 39(1): 8–16.</ref>
	*Many patients recover within 3 to 6 months of disease onset<ref>Bhattacharyya A et Al. Peripartum Cardiomyopathy: A Review. Tex Heart Inst J. 2012; 39(1): 8–16.</ref>		*Many patients recover within 3 to 6 months of disease onset<ref name="Peripartum Cardiomyopathy">Bhattacharyya A et Al. Peripartum Cardiomyopathy: A Review. Tex Heart Inst J. 2012; 39(1): 8–16.</ref>

	==See Also==		==See Also==

Rossdonaldson1: /* PrognosisBhattacharyya A et Al. Peripartum Cardiomyopathy: A Review. Tex Heart Inst J. 2012; 39(1): 8–16. */

2022-06-07T22:37:20Z

PrognosisBhattacharyya A et Al. Peripartum Cardiomyopathy: A Review. Tex Heart Inst J. 2012; 39(1): 8–16.

← Older revision		Revision as of 22:37, 7 June 2022
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	*Admit		*Admit

	==Prognosis<ref>Bhattacharyya A et Al. Peripartum Cardiomyopathy: A Review. Tex Heart Inst J. 2012; 39(1): 8–16.</ref>==		==Prognosis==
	*Mortality rate up to 10%		*Mortality rate up to 10%<ref>Bhattacharyya A et Al. Peripartum Cardiomyopathy: A Review. Tex Heart Inst J. 2012; 39(1): 8–16.</ref>
	*High risk of recurrence in subsequent pregnancies		*High risk of recurrence in subsequent pregnancies<ref>Bhattacharyya A et Al. Peripartum Cardiomyopathy: A Review. Tex Heart Inst J. 2012; 39(1): 8–16.</ref>
	*Many patients recover within 3 to 6 months of disease onset		*Many patients recover within 3 to 6 months of disease onset<ref>Bhattacharyya A et Al. Peripartum Cardiomyopathy: A Review. Tex Heart Inst J. 2012; 39(1): 8–16.</ref>

	==See Also==		==See Also==

ClaireLewis at 19:38, 21 August 2019

2019-08-21T19:38:58Z

← Older revision		Revision as of 19:38, 21 August 2019
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	==Background==		==Background==
	*Uncommon cause of heart failure		*Uncommon cause of [[heart failure]]
	*Incidence: 1:968 to 1:4000 in the United States<ref>Sliwa K et al.		*Incidence: 1:968 to 1:4000 in the United States<ref>Sliwa K et al.
	Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail. 2010;12(8):767. PMID:		Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail. 2010;12(8):767. PMID:
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	==Differential Diagnosis==		==Differential Diagnosis==
	*~~Respiratory tract infection~~		*[[Pneumonia]]
	*[[PE]]		*[[PE]]
	*[[MI]]		*[[MI]]
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	*[[ECG]]		*[[ECG]]
	*[[CXR]]		*[[CXR]]
	*CBC & LFTs, screen for thrombocytopenia or transaminitis that can be found with severe pre-eclampsia		*CBC & [[LFTs]]
			**screen for [[thrombocytopenia]] or transaminitis that can be found with severe pre-eclampsia
	*Chemistry		*Chemistry
	*TSH		*TSH
	*TTE~~, bedside~~ can show LV dilation and LV systolic dysfunction		*[[Echocardiography]]
	*BNP		**bedside TTE can show LV dilation and LV systolic dysfunction
			*[[BNP]]

	===Diagnosis===		===Diagnosis===
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	==Management==		==Management==
	*Treat like usual heart failure ~~(except~~ avoid ~~nitroprusside~~ and ~~ACEI in pregnancy)~~		*Treat like usual heart failure
	*If pregnant~~, fetal monitoring can assist in evaluating uterine perfusion~~		*Consider anticoagulation if EF <30% during and 2-3mo after delivery; avoid warfarin and DOACs
	*Avoid phenylephrine and norepinephrine ~~if pregnant due to~~ increased vasoconstriction of uterine arteries ~~leading~~ to ~~placental insufficiency~~		*If pregnant:
	*Consider anticoagulation for EF <~~30% during pregnancy~~ and ~~within 2-~~3 ~~months following delivery (avoid warfarin and DAOCs~~)		**'''Avoid''' [[nitroprusside]] and [[ACEI]]
	*~~Beta-blockers improve survival~~ and ~~are safe~~ in ~~pregnancy, but should not be given in acute decompensated heart failure~~		**Use of [[phenylephrine]] and [[norepinephrine]] controversial
			***Some animal/in vitro studies suggest increased vasoconstriction of uterine arteries may lead to adverse fetal outcome, however evidence of effect on human uterine arteries is limited<ref>Van Nimwegen D, Dyer DC. The action of vasopressors on isolated uterine arteries. Am J Obstet Gynecol. 1974;118(8):1099.</ref> <ref>Branco D, Caramona M, Martel F, de Almeida JA, Osswald W. Predominance of oxidative deamination in the metabolism of exogenous noradrenaline by the normal and chemically denervated human uterine artery. Naunyn Schmeidebergs Arch Pharmacol. 1992 Sep;346(3):286-93.</ref>
			***Maternal hypotension is bad for both mother and fetus!
			**Consider fetal monitoring to assist in evaluating uterine perfusion

	==Disposition==		==Disposition==

Gregtong: /* Management */

2019-08-20T23:52:00Z

Management

← Older revision		Revision as of 23:52, 20 August 2019
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	==Management==		==Management==
	*Treat like usual heart failure (except avoid nitroprusside and ACEI)		*Treat like usual heart failure (except avoid nitroprusside and ACEI in pregnancy)
			*If pregnant, fetal monitoring can assist in evaluating uterine perfusion
			*Avoid phenylephrine and norepinephrine if pregnant due to increased vasoconstriction of uterine arteries leading to placental insufficiency
			*Consider anticoagulation for EF <30% during pregnancy and within 2-3 months following delivery (avoid warfarin and DAOCs)
			*Beta-blockers improve survival and are safe in pregnancy, but should not be given in acute decompensated heart failure

	==Disposition==		==Disposition==

Gregtong: /* Workup */

2019-08-20T23:37:25Z

Workup

← Older revision		Revision as of 23:37, 20 August 2019
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	*Chemistry		*Chemistry
	*TSH		*TSH
	*TTE		*TTE, bedside can show LV dilation and LV systolic dysfunction
	*BNP		*BNP

Gregtong: /* Workup */

2019-08-20T23:36:47Z

Workup

← Older revision		Revision as of 23:36, 20 August 2019
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	*[[ECG]]		*[[ECG]]
	*[[CXR]]		*[[CXR]]
	*CBC		*CBC & LFTs, screen for thrombocytopenia or transaminitis that can be found with severe pre-eclampsia
	*Chemistry		*Chemistry
	*TSH		*TSH

Gregtong: /* Workup */

2019-08-20T23:35:42Z

Workup

← Older revision		Revision as of 23:35, 20 August 2019
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	*TSH		*TSH
	*TTE		*TTE
			*BNP

	===Diagnosis===		===Diagnosis===

Davycro: /* Background */

2019-06-20T15:08:59Z

Background

← Older revision		Revision as of 15:08, 20 June 2019
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	==Background==		==Background==
	*Uncommon cause of heart failure		*Uncommon cause of heart failure
	*Incidence: 1:968 to 1:4000 in the United States		*Incidence: 1:968 to 1:4000 in the United States<ref>Sliwa K et al.
			Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail. 2010;12(8):767. PMID:
			20675664</ref>

	==Clinical Features==		==Clinical Features==

Davycro: /* Background */

2019-06-20T15:02:58Z

Background

← Older revision		Revision as of 15:02, 20 June 2019
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	==Background==		==Background==
	*Uncommon cause of heart failure		*Uncommon cause of heart failure
			*Incidence: 1:968 to 1:4000 in the United States

	==Clinical Features==		==Clinical Features==