Chinweuba Goodness C, Rutkofsky Ian H
Obstetrics and Gynecology, Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Cureus. 2020 Oct 4;12(10):e10790. doi: 10.7759/cureus.10790.
Peripartum cardiomyopathy (PPCM) can be classified as a variant of dilated cardiomyopathy identified usually within the first five months of delivery or during the last month of pregnancy. This condition presents as systolic heart failure. PPCM affects thousands of women in the United States each year. Even though it was first noticed in the 1800s, its etiology remains unknown. This study aims to review the pathophysiology and management of PPCM and explore the possible outcomes of peripartum cardiomyopathy. PPCM can lead to maternal death if diagnosis or treatment is delayed. Diagnosing PPCM has been challenging because it can be misdiagnosed or perceived as a sign of pregnancy since most of the symptoms of PPCM strongly match those within the typical pregnancy continuum and postpartum cycle. Patients' implications are fatal and carry a high mortality rate when PPCM is misdiagnosed or treatment is delayed. To accurately identify PPCM, using echocardiography, the left ventricular end-diastolic size and the ejection fraction should be measured to determine the severity of PPCM. Managing peripartum cardiomyopathy involves using traditional treatments for heart failure. Therapeutic recommendations are made depending on the patient's status (pregnancy, breastfeeding, postpartum) while considering the drug-safety profiles before administration. Some other treatments have also been used to control PPCM depending on how severe it has become; for example, antiarrhythmics have been used to treat cardiac arrhythmias when they ensue. In extreme cases, mechanical assistance and transplantation could be required. Based on the proposed pathophysiology involving the 16kDA anti-angiogenic sub-fragment, bromocriptine may be used even though it still needs more assessment due to limited evidence. Using PubMed as a major search resource, a thorough analysis of publications was carried out after incorporating this review's inclusion and exclusion criteria. A total of 455,141 publications were found using keywords and keyword combinations. With a careful selection of articles, 31 publications provided relevant information on our primary endpoint. All articles in this examination were chosen without limitation to the type of study, including clinical trials, review articles, meta-analyses, and so on. Our review suggests that, based on factors such as early detection and management, disease severity, ethnicity, and quality of patient care, patients with PPCM presented different outcomes and prognosis. However, despite PPCM's high mortality rate and its risk of recurrence, most patients tend to recover within six months of disease onset.
围产期心肌病(PPCM)可归类为扩张型心肌病的一种变体,通常在分娩后的前五个月内或妊娠的最后一个月被确诊。这种病症表现为收缩性心力衰竭。在美国,每年有数千名女性受PPCM影响。尽管它在19世纪就首次被发现,但其病因仍然不明。本研究旨在回顾PPCM的病理生理学和管理方法,并探讨围产期心肌病可能的转归。如果诊断或治疗延迟,PPCM可导致产妇死亡。诊断PPCM具有挑战性,因为它可能被误诊或被视为妊娠的一种表现,因为PPCM的大多数症状与典型妊娠持续期和产后周期内的症状高度匹配。当PPCM被误诊或治疗延迟时,对患者的影响是致命的,死亡率很高。为了准确识别PPCM,应使用超声心动图测量左心室舒张末期大小和射血分数,以确定PPCM的严重程度。管理围产期心肌病涉及使用传统的心力衰竭治疗方法。根据患者的状态(妊娠、哺乳、产后)制定治疗建议,同时在给药前考虑药物安全性。根据PPCM的严重程度,还使用了一些其他治疗方法来控制病情;例如,当出现心律失常时,使用抗心律失常药物来治疗。在极端情况下,可能需要机械辅助和移植。基于涉及16kDA抗血管生成亚片段的拟议病理生理学,尽管由于证据有限仍需要更多评估,但可以使用溴隐亭。以PubMed作为主要搜索资源,在纳入本综述的纳入和排除标准后,对出版物进行了全面分析。使用关键词和关键词组合共找到455,141篇出版物。经过仔细筛选文章,31篇出版物提供了与我们主要终点相关的信息。本次审查中的所有文章均不受研究类型的限制而被选中,包括临床试验、综述文章、荟萃分析等。我们的综述表明,基于早期检测和管理、疾病严重程度、种族和患者护理质量等因素,PPCM患者呈现出不同的转归和预后。然而,尽管PPCM死亡率高且有复发风险,但大多数患者在疾病发作后六个月内倾向于康复。