Peripartum Cardiomyopathy: Symptoms, Diagnosis, and Treatment

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Pregnancy and childbirth are never without surprises. But for most of us, things go relatively smoothly, aside from fatigue and other bodily discomforts, we generally aren’t left with many serious lingering health issues. That being said, in rare cases, new mothers encounter serious problems related to their pregnancies.

Peripartum cardiomyopathy is one such issue. The condition, which usually strikes during or right after pregnancy, can have serious consequences for the functionality of your heart, as well as your lungs and other organs.

However, while a very serious condition, there are many effective ways to treat peripartum cardiomyopathy, and most mothers are able to lead normal, healthy lives after a timely diagnosis and care plan.

What Is Peripartum Cardiomyopathy?

Peripartum Cardiomyopathy

Peripartum cardiomyopathy is a condition characterized by a weakening of the heart muscles. As a result, the chambers of your heart may enlarge and it may become more difficult for your heart to pump blood. This can have a direct effect on the “ejection fraction” of your heart which is the percentage of blood your heart is able to pump out with each of your heartbeats.

A normal ejection fraction percentage is about 60%. Once your rate dips below that, extra fluid may build up in your body, especially in your lungs or extremities.

Severity of peripartum cardiomyopathy differs greatly from mother to mother. In less severe cases, recovery may be easier and mothers may be able to completely recover from the disorder.

In severe cases of peripartum cardiomyopathy, your heart is unable to meet the body's need for oxygenation and your vital organs may become affected. If the condition becomes extremely severe or is not properly addressed, cardiac arrest can occur or be fatal.

Causes

In most cases, peripartum cardiomyopathy occurs in the last months of pregnancy, or in the first four or five months after giving birth. Peripartum cardiomyopathy is very rare, and only occurs in 0.1% of pregnancies.

Many women who are diagnosed with peripartum cardiomyopathy do recover, but recovery can take anywhere from two weeks to six months—or longer. A small percentage of women continue to experience symptoms for years or for a lifetime. Sadly, in rare cases peripartum cardiomyopathy becomes fatal.

Medical experts are not sure what causes peripartum cardiomyopathy, but believe it’s a combination of factors, including genetic, environmental, and inflammatory aspects. While experts have not found any causal links, they believe there are certain factors that may put a person at a higher risk of peripartum cardiomyopathy, including:

  • Being African American/Black
  • Giving birth to more than one child
  • Being older than 30
  • Giving birth to twins
  • Having experienced eclampsia, preeclampsia, or hypertension

Symptoms

Most cases of peripartum cardiomyopathy occur at the end of pregnancy or within the first four months postpartum; only 10% of cases occur after four months postpartum. Symptoms of peripartum cardiomyopathy vary from mother to mother, but the most common symptoms include:

  • Swelling of hands and feet (edema)
  • Shortness of breath, especially when lying down
  • Shortness of breath that may wake you at night
  • Extreme fatigue
  • Weight gain
  • Coughing
  • Rapid heartbeat
  • Chest pain

If you have any of those symptoms, especially if they are intense or come on suddenly, you should contact your doctor right away. Not all of these symptoms necessarily point to peripartum cardiomyopathy, but all are serious and warrant medical attention.

Diagnosis

Many of the symptoms of peripartum cardiomyopathy overlap with symptoms common to pregnancy such as fatigue and swelling of the extremities. Some of the symptoms also overlap with other serious pregnancy conditions such as preeclampsia. That’s why you need to get a full medical work-up in order to be properly diagnosed with peripartum cardiomyopathy.

If your doctor suspects that you may have peripartum cardiomyopathy, they may perform one or more of the following tests:

  • Blood tests
  • Echocardiograms
  • X-rays of your chest
  • Magnetic Resonance Imaging (MRI) tests

Other diagnostic tests may need to be performed based on your symptoms or prognosis.

Treatment

Depending on the severity of your case of peripartum cardiomyopathy, your doctor may take one of several approaches. Mild cases of peripartum cardiomyopathy may only require strict monitoring of symptoms. However, in cases where your heart is not pumping enough blood for your body to function properly, you have become short of breath, or fluid is accumulating in your body, interventions will be necessary.

The most common treatments for these symptoms include:

  • Diuretics: These medications decrease fluid build-up in your body
  • Beta blockers: These medications slow down your heart rate so that your heart can recover more easily between beats
  • ACE (angiotensin converting enzyme) inhibitors: These medications widen your blood vessels, increasing blood volume and decreasing your blood pressure.

Your medical team may use other treatments, depending on your needs. In very rare cases, heart pumps or even heart transplants may be recommended. Most of the medications you will be given will be compatible with breastfeeding. If they aren’t, usually an alternative, breastfeeding-friendly medication can be given.

Can You Have More Children?

If you have been diagnosed with peripartum cardiomyopathy, you may be wondering what this means for your family planning timeline, and if it will be safe for you to become pregnant again.

This answer depends very much on the severity of your peripartum cardiomyopathy and your recovery from it.

If, by the time you are considering a new pregnancy, your heart has recovered to full capacity, it is generally safe for you to have another baby. However, your pregnancy will need to be monitored carefully and you will be considered high risk.

Unfortunately, if your heart has not recovered completely, it will usually be advised that you should not try to get pregnant again. This may be heartbreaking news, but a new pregnancy could cause significant risk to you and/or your baby.

A Word From Verywell

Being diagnosed with something like peripartum cardiomyopathy can be shocking and scary. The good news is that, while serious, the condition is something that can be treated and many moms go on to recover from it. Still, some moms do experience long-term damage, which can be extremely distressing.

If you have been diagnosed with peripartum cardiomyopathy, don’t be afraid to ask your doctors as many questions as you need to. It’s likely that you will have many concerns, and these are all valid.

It’s also important that you reach out for help if you find that this diagnosis is having an impact on your mental health or your ability to care for your baby. A diagnosis like peripartum cardiomyopathy is significant, and you deserve to be cared for, listened to, and well supported.

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Article Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Journal of Critical Care. Peripartum Cardiomyopathy: Review and Practice Guidelines. Updated March 1, 2012.

  2. John Hopkins Medicine. What Is Peripartum Cardiomyopathy? Updated January 14, 2021.

  3. Bhattacharyya A, Basra SS, Sen P, Kar B. Peripartum cardiomyopathy: a review. Texas Heart Institute Journal. 2012;39(1):8-16.

Additional Reading
  • Barouch L. Peripartum Cardiomyopathy. John Hopkins Medicine website. Updated January 6, 2021.

  • Jensen L, Johnson-Coyle L, Sobey A. Peripartum Cardiomyopathy: Review and Practice Guidelines. American Journal of Critical Care. 2012;21(2):89–98. doi:https://doi.org/10.4037/ajcc2012163.

  • Peripartum Cardiomyopathy (PPCM). University of Michigan Cardiovascular Center website. Updated January 6, 2021.