Worried about peripartum cardiomopathy

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Submitted by Dr T on July 9, 2011 – 10:21am

I have pregnancy induced PVC’s and PAC’s with some runs of NSVT.  A holter showed I have about 7000 per day.  I had an echo done in May that was clear.  But, I have heard of peripartum cardiomopathy which occurs in the final month or months after pregnancy, and I am concerned that I may be at risk for this due to my high number of PVC’s. 
How quickly can this condition develop?  If I had an echo which was clear in May, is it still possible for my heart muscle to become enlarged due to Peripartum CM in the next couple of months or would there have been signs of progressive enlargement on that echo? (I am 37 weeks pregnant)   Thank You in advance for your feedback.

Palpitations, PVCs and PACs if they occur during pregnancy may happen secondary to hormonal changes. If new, they should be evaluated like any other arrhythmia, with blood tests, EKGs and a Holter monitor. I am sure those PVCs, PACs and runs of NSVT are very bothersome, but they don’t necessarily lead to a Peripartum cardiomyopathy (PPCM), and they should be treated like any other arrhythmia if your doctors think it indicated.

Since your ECHO was normal at the time, the only thing I would advice you is to follow this up regularly till after the baby is born. However, unless changes occur I think it unlikely you will develop PPCM. Most likely they are benign and you will not have to worry about them and they should go away after you have the baby.

Please check these links for more information about palpitations and PVCs:

Most people don’t need treatment, only reassurance once their heart proves OK. Thus a patient with a new onset of symptoms  needs testing, both of the heart rhythm and a variety of blood tests to make sure there is no other heart problem.

Peripartum cardiomyopathy (PPCM) occurs in the last months of pregnancy and up to five months after delivery. Arrhythmias are sometimes a complication of PPCM, a form of dilated cardiomyopathy. This is a condition in which the heart becomes weakened and enlarged and cannot pump blood efficiently. This can lead to heart failure, with fluid buildup in the lungs or other parts of your body, arrhythmias and even sudden cardiac death. Patients usually have no prior history of heart disease or heart failure. Cardiac ECHOs are used to diagnose and monitor its treatment.

The severity of symptoms in patients with PPCM can be classified by the New York Heart Association system as follows:

  • Class I – Disease with no symptoms
  • Class II – Mild symptoms/effect on function or symptoms only with extreme exertion
  • Class III – Symptoms with minimal exertion
  • Class IV – Symptoms at rest

Symptoms  such as dyspnea, dizziness and decreased exercise capacity may occur in pregnant women. Mild dyspnea on exertion is also common in a normal pregnancy and therefore patients may present with heart failure or a major adverse event such as a stroke or respiratory failure without any previous signs or symptoms. Fetal distress may be a result of the mother’s heart failure: a healthy fetus depends on a healthy mother!

Treatment may be complicated and require transfer to a hospital with facilities available to care for both mother and child.

The prognosis is dependent on recovery of the heart function. Thirty percent of patients return to baseline heart function within 6 months, and 50% of patients have significant improvement in symptoms.

Hope this helps,
Dr T

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