What Is Peripartum Cardiomyopathy (PPCM)?

Pregnancy takes a toll on your body even when it's free of complications. But in rare cases, it can lead to a serious form of heart disease known as peripartum cardiomyopathy (PPCM). Here are the warning pregnant women and their families should get familiar with and when to seek help.

What is peripartum cardiomyopathy or PPCM?

Peripartum cardiomyopathy (PPCM) — also known as postpartum or pregnancy-associated cardiomyopathy — is a rare form of heart failure that shows up the first five to six months after delivery or, less commonly, during the last month of pregnancy.

It occurs when the heart's chambers enlarge and its muscles weaken, preventing this vital organ from pumping enough oxygen-rich blood to the rest of the body. It can sap a new mom's or mom-to-be's strength and make breathing difficult.

PPCM affects about 1,000 to 1,300 American women each year, and according to American College of Obstetricians and Gynecologists (ACOG), it's the leading cause of maternal deaths in the U.S. This condition also has higher mortality rates for women of color and low-income women. That's why it's so important to know the signs and seek the proper diagnosis and treatment if they occur.

Peripartum cardiomyopathy symptoms

Symptoms of peripartum cardiomyopathy can vary depending on the severity of the condition, but the most typical signs include:

• Fatigue. While many women experience late-pregnancy or new-mom fatigue, feeling more tired than usual is one sign to watch out for.
• Heart palpitations or chest pain. These can feel like skipped heartbeats or a racing heart.
• Shortness of breath. If mild, it can mimic the shortness of breath commonly felt during the third trimester (or postpartum when you're recovering, busy with baby and sleep-deprived). More severe shortness of breath is what you want to keep an eye out for, especially if it’s experienced when lying down.
• Swelling in the feet and legs. This, too, is tough to distinguish from normal edema during pregnancy. If you have extreme, sudden or unusual swelling, talk to your doctor. PPCM can cause the heart to pump improperly, and fluid can accumulate in the lower extremities. You may also notice swollen neck veins.
• Low blood pressure. Sometimes, women who get PPCM experience a drop in blood pressure when standing up (but not when they're seated or lying down). 

Many PPCM symptoms mimic the signs of more benign conditions, which makes them easy to brush off — but it's important to talk to your doctor if you're experiencing any of them.   

When does peripartum cardiomyopathy typically surface?

PPCM can surface any time during the last month of pregnancy or, more typically, within the first five to six months after delivery — but in 80 percent of cases, it occurs within three months of giving birth, according to the American Heart Association. About 10 percent of cases show up in the last month of pregnancy.

The condition can be hard to detect because some of its symptoms — fatigue, swelling, shortness of breath and so on — are very similar to those of the last trimester of pregnancy or early postpartum. Still, you must talk to your doctor if you're experiencing them. He or she may run tests, including an echocardiogram (an ultrasound of the heart), to rule out PPCM.

PPCM risk factors and causes

It’s unclear what causes PPCM, but some evidence suggests there's a genetic component behind it. Still, the risk factors most associated with developing peripartum cardiomyopathy include:

• A history of PPCM in a previous pregnancy
• A history of heart issues, such as inflammation of the heart muscle (myocarditis) or small-vessel disease
• A history of smoking
• A history of alcoholism
• African-American descent
• Poor nutrition
• Obesity
• Carrying multiples
• Age (more than half of women who develop PPCM are over 30 years old)
• Preeclampsia or gestational hypertension

Treatments for peripartum cardiomyopathy

Treatment of PPCM focuses mainly on relieving the symptoms and preventing excess fluid from collecting in the lungs. Some remedies can be used to help the heart get back to normal.

Your doctor will prescribe medications based on whether you’re still pregnant or have already delivered. Peripartum cardiomyopathy treatment options may include: 

Medications

Many of these are safe for breastfeeding moms — though, depending on the severity of the condition, your doctor may recommend that you not breastfeed. Types of medication used treat the symptoms and help the heart recover include:

• Digitalis to strengthen the heart
• ACE inhibitors to help the heart work efficiently
• Blood pressure medicine to give the heart time to heal
• Anticoagulants to help thin blood to reduce the risk of blood clots
• Diuretics to reduce fluid retention

Lifestyle changes

• Dietary changes, including salt restriction, to help treat the symptoms and heal the heart
• Stopping smoking or drinking alcohol

Is there any way to prevent peripartum cardiomyopathy?

There’s no way to prevent peripartum cardiomyopathy entirely, but you can reduce your risk by taking good care of your heart. That includes avoiding smoking and excess drinking, eating a well-balanced diet and getting regular exercise.

If you’ve had PPCM in one pregnancy, you’re at much higher risk of developing it again in subsequent pregnancies — so it's especially important that you work in close concert with your medical team to determine if it’s safe for you to conceive again and whether you’ll need to certain medications while you're expecting.

How can peripartum cardiomyopathy affect my pregnancy and me?

Women who develop severe peripartum cardiomyopathy toward the end of pregnancy will usually have their babies delivered right away. Moms-to-be with a less severe form of the disease will receive close monitoring, and they may need to deliver early only if their condition becomes unstable.

Because most cases of PPCM occur after delivery, the biggest effect is on the health of the new mom. Approximately half of all women who develop PPCM recover completely, with their heart returning to normal with treatment, although it's still important for them to approach future pregnancies carefully.

For others, the heart may not be able to recover. In those cases, a future pregnancy could put a mom's life in danger, since it could result in heart failure. Other possible complications include cardiac arrhythmias (irregular heartbeats that could be dangerous) or blood clots.

Though peripartum cardiomyopathy is a serious condition, the available treatments can restore a new mom’s heart function and help her feel better.

Talk to your practitioner at any time during pregnancy or postpartum if you have questions or are at all concerned about PPCM. And remember, though it's important to be vigilant about the warning signs, the chances that you'll have PPCM either during pregnancy or after your baby arrives are slim.