Pregnancy and the anticipation of new life is a time of excitement for most women. The gestation period is also tinged with some anxiety about the health of the child, and a safe delivery. Most pregnancies are relatively trouble-free, but there are those pregnancies which do not evolve as planned. Take a woman in her late thirties and pregnant for the third time. Previous pregnancies and deliveries were fairly routine and uncomplicated. Until today, this pregnancy was as normal as pregnancies ever are. Labor starts and after 30 some hours the doctor decides that a cesarean delivery is advisable. The operation proceeds normally and within the hour a new baby has arrived. The balance of the hospital stay meets the criteria established for release from the hospital and the new mother and baby go home. Within three days the mother is having problems breathing and relatives start to take her to the emergency room, but en route she cannot breathe at all and it is necessary to call for emergency transportation to complete the trip. The local hospital transfers the patient to a regional hospital that specializes in heart disorders.
The patient has been diagnosed with PPCM (peripartum cardiomyopathy). PPCM is a rare form of dilated cardiomyopathy in which a weakened heart is diagnosed in the final month of pregnancy or within a few months after delivery. Cardiomyopathy is considered peripartum when there is absence of heart disease prior to the pregnancy and no other cause can be found. As with all forms of heart problems the heart cannot effectively support the body and the condition affects the lungs, liver and other body systems. In this country, PPCM is a complication of 1 in every 2,000 - 4,000 deliveries. It can occur in any race, at any age during reproductive years, and during any pregnancy.
Symptoms can include difficulty breathing while lying flat, shortness of breath with exertion, edema, cough, frequent night-time urination, and heart palpitations. Patients as well as health care professionals frequently dismiss symptoms as part of normal pregnancy. Early detection and treatment are extremely important to the PPCM patient. Delays in treatment are associated with increased mortality.
PPCM has no known cause. Researchers are investigating viruses, auto immune system problems, nutrient or mineral deficiencies and genetics as possibilities that contribute to or cause PPCM.
The Internet Journal of Anesthesiology, 2007, Volume 12 Number 1 lists case histories of patients with PPCM and the treatments that were used for these patients. The underlying theme of this and other research is that both the patients and health care providers need to be more aware of the symptoms. Patients need to be persistent when seeking treatment if they exhibit any of the symptoms usually associated with PPCM.
In 2000 the National Heart, Lung, and Blood Institute and Office of Rare Disease (National Institutes of Health) Workshop Recommendations and Review concluded: "Peripartum cardiomyopathy is a rare lethal disease about which little is known.
Diagnosis is confined to a narrow period and requires echocardiograph evidence of left ventricular systolic dysfunction. Symptomatic patients should receive standard therapy for heart failure, managed by a multidisciplinary team. If subsequent pregnancies occur, they should be managed in collaboration with a high-risk perinatal center. Systematic data collection is required to answer important questions about incidence, treatment, and prognosis. "
A Mother's Heart is a non-profit online organization found at www.amothersheart.org dedicated to providing up-to-date medical information regarding the disease. It also provides the largest online support group for PPCM world-wide. Access to the support group is http://www.amothersheart.org/members/index.php
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