Peripartum Cardiomyopathy and Cardiogenic Shock
- Definition of Peripartum Cardiomyopathy (PPCM):
Diagnosis includes heart failure near the end of pregnancy or within five months postpartum, with LV ejection fraction <45% and idiopathic LV dysfunction excluding other causes. - Role of PAC in Cardiogenic Shock:
Parameters like cardiac power output (CPO) and pulmonary artery pulsatility index (PAPi) guide mechanical support needs. - Unique HF Management in PPCM:
Some GDMT agents like ACE-I and ARBs are contraindicated in pregnancy. Deferring ICD for six months is advised as recovery of LV function is possible. - Special PPCM Management Considerations:
Anticoagulation may be indicated due to the prothrombotic state in pregnancy. Bromocriptine is also investigated in PPCM management. - Long-Term PPCM Management:
Pregnancy may be advised against if EF does not recover to >50-55%. Early contraception counseling is critical for future pregnancy planning.
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