Peripartum Cardiomyopathy

Peripartum cardiomyopathy (PPCM) is a diagnosis of exclusion manifesting as acute systolic heart failure towards the end of pregnancy or in the months that follow. Elevated BNP or NT-proBNP and echocardiogram with evidence of systolic dysfunction are key diagnostic tools. During and after pregnancy beta-blockers can be continued and pulmonary congestion can be relieved by diuretics. Guideline-directed medical therapy for heart failure with reduced ejection fraction needs to be modified during pregnancy and lactation, but many medications can be used safely. Prognosis and outcomes are variable and patients should be followed closely by a multidisciplinary team. Counseling about subsequent pregnancies needs to be done by a specialist with experience managing these patients and is usually reserved for patients with complete myocardial recovery. Reliable contraception and reproductive plans need to be addressed.