Perinatal Cardiomyopathy

The article was written by MSc Vu Thi Tuyet Mai - Cardiologist - Cardiovascular Center - Vinmec Central Park International General Hospital

Frequency: Occurs in about 1/2889 women living in the United States. It is more common in African-American women, is most common in Haiti (1/300), and is nearly 10 times higher in the United States (cause unknown). Mortality: Nearly 50% in Haiti, and in the United States: 0-5%

To date, despite numerous studies, it has been difficult to determine the etiology and pathogenesis of perinatal cardiomyopathy. The chain of inflammatory reactions that initiates the process of myocardial damage, causing necrosis, fibrosis, and programmed death is the foundation for reducing myocardial contractility, causing heart failure.
Although there are many theories, there are currently 2 causes that are believed to have the most connection, which is hormonal changes due to pregnancy, especially prolactin and the second cause is myositis. viral heart.
Demakis et al. suggest the following risk factors for SRB:
Multiple births, multiple pregnancies Older mothers (more common in people > 30 years) Preeclampsia, high blood pressure in pregnancy African-American race Poor nutrition, alcoholism

Most cases, 82% of cases are detected within 3 months postpartum (45% diagnosed in the first week, 75% in the first month after birth), only about 7% of cases are diagnosed in the last month of pregnancy.
Like general heart failure syndrome, heart failure due to CBC has all the clinical symptoms of a heart failure condition such as:
Limitation of physical activity, shortness of breath, shortness of breath (90%) Ankle edema (90%) 62%) Cough when lying with head low Tachycardia, palpitations (60%) A problem is that the symptoms of dyspnea, peripheral edema and tachycardia are possible manifestations in a pregnant woman normal, especially in the last months of pregnancy. This is the reason why many CSC patients are diagnosed late and it is a challenge for obstetricians and even cardiologists to diagnose heart failure in patients in the third trimester of pregnancy. . It is easier to diagnose BCC when the patient shows symptoms of heart failure in the postpartum period.

If the doctor is in doubt, he may order some tests such as: Electrocardiogram, BNP biomarkers, NT-Pro BNP, Troponin I, echocardiography, cardiac MRI to confirm the diagnosis.
Diagnostic criteria:
4 criteria are needed:
(1) Occurrence of symptoms of heart failure in the perinatal period (1 last month before birth or within 5 months after birth).

(2) No evidence of prior heart failure until diagnosis.
(3) No other medical cause has been identified as likely to cause heart failure.
(4) Echocardiographic criteria: Ejection fraction (EF) ≤ 45%, and or LV contracture fraction < 30%, and left ventricular end-diastolic diameter ≥ 2.7 cm/m2.

4.1 Treatment of heart failure during pregnancy Fluid restriction < 2 liters/day, salt restriction 2-4 g/day, exercise restriction Drugs that may be used: Digoxin, beta-blockers, diuretics loops, hydralazine, nitrates: safe and are the main drugs used to treat heart failure in pregnant women. ACE inhibitors and AT1 receptor blockers (ARBs): contraindicated during pregnancy because of the potential for fetal malformations. 4.2 Treatment of postpartum heart failure Basically, treatment is the same as treatment in the prenatal period, only adding an ACE inhibitor, angiotensin II receptor blocker – a drug group capable of improving mortality for patients with heart failure with impaired left ventricular function. The drugs captopril and enalapril are usually chosen if the patient is breastfeeding – because these drugs are excreted in breast milk.
In some rare severe cases, surgery is needed to implant a heart assist device or perform a heart transplant.

Fortunately, most women with SCC will partially or completely recover heart function. However, it is important to follow up closely and follow up with the doctor's appointment.
If you are planning to become pregnant again, consult your doctor to assess your risk. If the echocardiogram shows that the heart function is still reduced, further pregnancy is not recommended, the pregnancy can worsen the heart failure, require a heart transplant, or cause death. Even patients who have an echocardiogram that shows their heart has fully recovered from their first pregnancy can develop heart failure if they become pregnant again.
A thorough evaluation by a cardiologist and a detailed discussion of the risks to mother-child pregnancy (high-risk pregnancy) should be recommended for any patient with a history of preconceptional SCC.
In addition, close coordination between obstetricians and cardiologists in the antenatal and labor period is essential to ensure the safety of mother and child. With the close cooperation between the departments at Vinmec International General Hospital, customers can be completely assured of the accuracy and safety of tests and examinations during pregnancy and childbirth.