Peripartum Cardiomyopathy is Missing

Letters to the Editor Diseases and Complications of the Puerperium by Dr. med. Susanne Schrey-Petersen, Dr. med. Anne Tauscher, Dr. med. Anne Dathan-Stumpf, and Prof. Dr. med. Holger Stepan in issue 25/2021

With interest we have read the recent article (1), which summarizes the main clinical profiles of women after childbirth. However, peripartum cardiomyopathy (PPCM) also contributes significantly to maternal morbidity and mortality during the peripartum period, and in our view should be included in this context.

PPCM is a heart disease that occurs in previously healthy women towards the end of pregnancy or in the first months after childbirth (with two-thirds of all cases occurring during childbed) (2). In Germany, around one in 1000 to 1500 pregnant women will develop PPCM. As the symptoms of PPCM (e.g., dyspnea, leg edema, orthopnea, fatigue) are unspecific and often difficult to distinguish from normal peripartum symptoms, there is often a considerable delay in diagnosis and consequently in therapy, which is associated with a poorer prognosis. This is precisely why we feel it is important to draw your attention to this dangerous peripartum disease, which can present differently, from acute heart failure to cardiogenic shock. The mortality rate from PPCM is 2% to 30%, and a significant proportion of women develops chronic heart failure (3). Therefore, early diagnosis and therapy are essential.

If the mentioned symptoms occur during the peripartum period, an immediate cardiological examination should be carried out. In most cases, the suspected diagnosis of PPCM can be ruled out or confirmed using a simple diagnostic algorithm (of echocardiography, determination of N-terminal pro-B-type natriuretic peptide [NT-proBNP], and electrocardiography, and if necessary, also chest x-ray) (2). If the suspected diagnosis of PPCM is confirmed, a specific therapy consisting of heart failure medication and the prolactin blocker bromocriptine in combination with thrombosis prophylaxis should be initiated promptly (4).

DOI: 10.3238/arztebl.m2022.0031

Dr. med. Tobias Jonathan Pfeffer

Dr. med. Dominik Berliner

Prof. Dr. med. Johann Bauersachs

Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Germany

Conflict of interest statement:

Prof. Bauersachs is Chair of the PPCM Study Group of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC).

The remaining authors declare that no conflict of interest exists.

References

1. Schrey-Petersen S, Tauscher A, Dathan-Stumpf A, Stepan H: Diseases and complications of the puerperium. Dtsch Arztebl Int 2021; 118: 436–46

2. Bauersachs J, König T, van der Meer P, Petrie MC, Hilfiker-Kleiner D, Mbakwem A, et al.: Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail 2019; 21: 827–43

3. Sliwa K, Petrie MC, van der Meer P, Mebazaa A, Hilfiker-Kleiner D, Jackson AM, et al.: Clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy: an ESC EORP registry. Eur Heart J 2020; 41: 3787–97

4. Hilfiker-Kleiner D, Haghikia A, Berliner D, Vogel-Claussen J, Schwab J, Franke A, et al.: Bromocriptine for the treatment of peripartum cardiomyopathy: a multicentre randomized study. Eur Heart J 2017; 38: 2671–9