Peripartum cardiomyopathy: a clinical review

Abstract

Peripartum cardiomyopathy (PPCM) is a potentially life-threatening form of heart failure that occurs in late pregnancy or the early postpartum period in previously healthy women. Characterized by left ventricular (LV) dysfunction and reduced LV ejection fraction (LVEF), PPCM shares pathophysiological features with other forms of dilated cardiomyopathy but presents unique challenges due to its association with pregnancy-related hormonal and vascular changes. While the exact etiology remains incompletely understood, oxidative stress, prolactin cleavage, inflammation, and genetic predisposition have been implicated in its pathogenesis. Diagnosis relies on echocardiographic evidence of systolic dysfunction in the absence of other identifiable causes of heart failure. Management strategies focus on optimizing heart failure therapy while considering the safety of both mother and fetus when treatment is initiated during pregnancy. Bromocriptine, an inhibitor of prolactin secretion, has emerged as a promising therapy, but its widespread use remains under investigation. Most patients experience significant recovery of cardiac function within six months postpartum; however, a subset progresses to chronic heart failure, transplantation, or death. This systematic review provides an in-depth analysis of current knowledge on the epidemiology, diagnostic challenges, and evolving therapeutic strategies for PPCM.

Keywords

Bromocriptine / heart failure / cardiovascular medicine / peripartum cardiomyopathy / women

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