Stewart Garrick C
Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA,
Curr Treat Options Cardiovasc Med. 2012 Dec;14(6):622-36. doi: 10.1007/s11936-012-0210-9.
Peripartum cardiomyopathy is diagnosed in women who develop systolic heart failure in the last month of pregnancy or within 5 months of delivery. This diagnosis should not be made in women with pre-existing cardiac disease or another cause of cardiac dysfunction. To prevent delay in diagnosis and treatment, a high index of suspicion is required given the overlapping symptoms of late pregnancy and heart failure. Traditional heart failure medical therapies are indicated, although drugs must be carefully reviewed for safety during pregnancy and lactation. Long-term prognosis is largely determined by the degree of ventricular recovery. Patients with acute or persistent hemodynamic compromise despite medical therapy should be considered for mechanical circulatory support and evaluated promptly for cardiac transplantation. A multidisciplinary team is required to care for patients with peripartum cardiomyopathy through parturition and beyond. All peripartum cardiomyopathy patients should be counseled that repeat pregnancy can negatively impact cardiac function and lead to recurrent heart failure or even death. Patients with persistent ventricular dysfunction should be strongly advised against another pregnancy.
围产期心肌病是指在妊娠最后1个月或分娩后5个月内发生收缩性心力衰竭的女性所患的疾病。患有先天性心脏病或其他心脏功能障碍病因的女性不应被诊断为此病。鉴于晚期妊娠和心力衰竭症状重叠，为防止诊断和治疗延误，需要高度怀疑。虽然在孕期和哺乳期必须仔细审查药物安全性，但仍需采用传统的心力衰竭药物治疗方法。长期预后很大程度上取决于心室恢复程度。尽管接受了药物治疗，但仍有急性或持续性血流动力学损害的患者应考虑接受机械循环支持，并迅速接受心脏移植评估。需要一个多学科团队来照顾围产期心肌病患者直至分娩及之后。所有围产期心肌病患者都应被告知，再次怀孕会对心脏功能产生负面影响，并导致复发性心力衰竭甚至死亡。应强烈建议持续性心室功能障碍患者不要再怀孕。
