A change of heart: case series: peripartum cardiomyopathy

Introduction Cardiac disease is the leading cause of maternal death in the United Kingdom. Peripartum cardiomyopathy (PPCM) accounts for about 17% of these deaths. We present a series of five women who presented with PPCM in Lanarkshire in recent years. Their presentations were variable clinically, and so, represent an important diagnostic challenge. Discussion Peripartum cardiomyopathy is an uncommon disease of pregnancy, characterised by the development of heart failure, due to left ventricular systolic dysfunction. The incidence of PPCM is estimated to be around 1 in 2000 live births, and is associated with high rates of maternal and neonatal mortality. Several predisposing factors have been identified, with genetics posited as having a key role in some subtypes. The pathophysiology is unclear. Recent evidence suggests a causative role for a cleavage product of prolactin, since protection is conferred by inhibition of prolactin by administration of bromocriptine in models and in pilot trials. Autoimmunity directed against cardiac beta-1-adrenoreceptors has also been implicated, and experimental evidence shows some potential for therapeutic intervention. Diagnosis is mainly clinical, though findings are often masked by the normal physiological changes seen in pregnancy. Favourable prognosis is dependent on recovery of left ventricular function: full recovery occurs in around half of cases, though significant percentage of cases results in persistent cardiomyopathy or mortality. The rate of recurrence is high in subsequent pregnancies. Due to its rarity, variability in presentation, and potential for mortality, PPCM should be considered in women at high risk, or presenting with suggestive symptoms.