Overview of Peripartum Cardiomyopathy

What Is Peripartum Cardiomyopathy?

What is it?

Peripartum Cardiomyopathy (PPCM) is a form of heart failure during the systolic phase of pumping i.e. the heart pumping with force to circulate blood in the body.

PPCM typically presents at late-stages pregnancy and in the early post-partum (after birth) period, if there are no other causes for heart failure found.

When experiencing PPCM, your left ventricle on your heart (which is responsible for pumping blood into your body) can become enlarged and weakened, therefore not pumping blood properly around the body.

As a result, blood can build up in areas of the body such as the lungs, leading to less oxygen for you and can have a noticeable effect such as breathlessness and extreme fatigue.

There are no clear underlying reasons why you may have developed PPCM, however there are suggestions from research that pregnancy-specific related conditions such as pre-eclampsia as well as risk factors such as diabetes and obesity are linked to PPCM. See the risk factors for PPCM section.

PPCM Statistics

Statistics

Most data comes from the United States, where it is estimated that PPCM exists in between one in 900 to one in 4000 births.

It is estimated that 50% of women who have PPCM had pre-eclampsia in their pregnancy, however this information is still being researched.

It is estimated that around 50-80% of women with PPCM will recover within the first six months of diagnosis, a figure which has improved substantially due to better recognition and treatment of PPCM.

Symptoms

Signs and Symptoms

It can be difficult to diagnose PPCM and typically it is a delayed diagnosis as many of the signs and symptoms are similar to that of normal changes to your body during pregnancy.

It is worth remembering that most women who have PPCM will develop the signs and symptoms within the first few months after giving birth.

Here are the signs and symptoms of PPCM:

  • Shortness of breath
  • Fluid retention and swelling around the legs
  • Palpitations
  • Fatigue
  • Chest pain
  • Abdominal discomfort due to swelling of the liver
  • Low blood pressure (hypotension)
Peripartum Cardiomyopathy Symptoms

Risk Factors

Risk Factors

There are a number of risk factors which have been associated with PPCM, however it is still not yet clear how women contract PPCM.

Below are some suggested risk factors for PPCM:

  • History of high blood pressure (hypertension)
  • Older age in pregnancy
  • Family history of cardiomyopathy
  • Had previous pregnancies
  • Overweight
  • Ethnicity (African-American women account for 40% of cases in the United States)
  • Preeclampsia in pregnancy. Information on pre-eclampsia can be found here.
Postpartum Cardiomyopathy Risks

Treatment for Peripartum Cardiomyopathy

Treatment for PPCM is similar to the management of heart failure; below is a list of ways your doctor could help you manage you PPCM.

Fluid restriction:

in order to reduce the pressure on your heart, your doctors may recommend only drinking between 1.5-2L of fluid daily.

Reduce salt intake:

aim for less than 2g per day. This page from the Queensland Government has some tips and tricks for reducing your salt intake.

Hospital admission:

having a stay in hospital may be required to get your symptoms under control.

Investigations:

you may need some investigations conducted to determine your severity of PPCM. These include blood tests, ultrasounds (echo) of the heart as well as a chest x-ray.

Medications:

medications may be prescribed to you to improve your symptoms and heart function. These medications include diuretics to help reduce fluid levels, beta blockers to relax your heart rate and ACE inhibitors to help your blood pressure. We recommend you discuss these with your doctor and pharmacist.

Prevention and Support

Follow the links below to find out more about how you can help prevent and support loved ones who have experienced Peripartum Cardiomyopathy

Prevention

Prevention

Currently, the suggestions for preventing PPCM are focused around heart health. These include maintaining a healthy weight range, regularly exercise, eating a healthy and balanced diet as well as not smoking.
Supporters

Supporters

A support group is a good way to meet people who have Peripartum Cardiomyopathy. Speaking to people who have a similar condition to you can help you understand as well as help with the healing process
Carers

Carers

If you are struggling to care for a loved one who has Peripartum Cardiomyopathy reach out discuss how you feel with someone today. Your well being and health as a carer is important too

FAQs

What you need to know

PPCM is diagnosed in women typically in the final month of pregnancy and within the first five months after giving birth. Whilst it is a rare syndrome, there are many linked risk factors including: pre-eclampsia, higher maternal age (typically over 30) as well as carrying multiple babies such as twins.

Symptoms of PPCM include shortness of breath, fluid retention and swelling around the legs, palpitations, fatigue, chest pain, abdominal discomfort due to swelling of the liver and low blood pressure (hypotension).

Long-term, it is estimated that around 50% of women will recover and have a normal or close to normal heart pumping function.

Women who do not fully recover have an increased risk of reduced heart function if having further pregnancy.

Regardless of recovery, all subsequent pregnancies need to be carefully managed by a medical team often including cardiologists and obstetricians.

If you are already diagnosed with any Heart Disease, we recommend speaking with your doctor and treating team to learn more about daily management. Research suggests that attending a Secondary Prevention Program can decrease the chance of being admitted to hospital, reduce your complications as well increase survival rates. One suggestion is cardiac rehabilitation, as these programs will teach you more about your disease, help you recover, empower you to make lifestyle changes to improve heart health as well as reduce your risk of further problems. Click here to find your nearest cardiac rehabilitation program.

Your doctor may have recommended that you take some new medications if you have PPCM. This could be an overwhelming time for you, especially as learn all about your new medications as well as any considerations for taking them. Apart from having a discussion with your doctor and pharmacist, NPS Medicinewise has some great information on medication management, medication disposal as well as risk factors. They also have some great information about medications for your heart, which can be found here.

It’s not too late to start looking after your heart health, even after a diagnosis of RHD.

Here are some great and easy everyday strategies you can do to look after your heart health:

Don’t smoke, as quitting smoking can reduce your risk by 50% in one year. Quitline would be a great way to start your quitting smoking journey.

Stay active, 30 minutes per day of exercise, such as walking, can reduce your risk by 30% and delivers many positive health benefits. More information about exercise as well as a sample walking session can be found here.

Get some sleep, aim for 7-8 hours sleep and aim to try and unplug from your technology (e.g. iPad) one hour before bedtime. The Sleep Health Foundation has many great women’s focused sleep pages for all stages of your life such as your menstrual cycle, pregnancy, new mothers and menopause.

Eat healthy: ensure you watch portion sizes, eat healthy and nourishing foods such as: high fibre foods (including oats and legumes), two pieces of fruit and seven serves of vegetables, reduced salt, three serves of fish per week, reducing saturated fats (such as chicken with skin on, baked goods, fried foods) whilst choosing more lean proteins such as tofu and trimmed meats. The Baker Heart and Diabetes Institute has created some handy factsheets to help you choose correct portions, supermarket shopping, healthy snacks and eating out.

Relax: try and take some time out for yourself, keep connected with friends and family, perhaps try activities such as meditation to help manage your stress levels. Beyond Blue has a great page full of practical stress relieving tips, and it could be worth to try some meditations from apps such as Smiling Mind, Headspace and Calm.

Peripartum Cardiomyopathy FAQ