Peripartum cardiomyopathy

Peripartum cardiomyopathy is an uncommon form of congestive heart failure associated with systolic dysfunction of left ventricle. The onset is characterised by symptoms of heart failure occurring between the last month of pregnancy and 5-6 months postpartum. The early diagnosis and the institution of medical treatment for this disease are essential because the inadequate management may affect the patient’s long-term prognosis and can lead to severe complications, including death.Currently its aetiology is not completely understood. Many aetiopathogenetic hypotheses have been formulated: inflammation, viral agents, autoimmune processes. In the last years, evidences aroused for a role of prolactin and its 16 kDa metabolite in reducing cardiomyocite metabolic activity and contraction. In this article we have reviewed the current literature with special emphasis on the role of prolactin and the related current treatment strategies. In particular, bromocriptine appears promising, even if women need to be informed that the drug stops the production of breastmilk. Further researchers, such as large multicenter trials, are needed to decide the best treatment for the women suffering of this disease.

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The relevance of prescribing triple neurohormonal blockade in real clinical practice: the role of mineralocorticoid receptor antagonists

Consilium Medicum ◽

10.26442/20751753.2021.6.200889 ◽

2021 ◽

Vol 23 (6) ◽

pp. 491-497

Author(s):

Igor V. Zhirov ◽

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Igor V. Zhirov ◽

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Mineralocorticoid Receptor ◽

Systolic Dysfunction ◽

Term Treatment ◽

Mineralocorticoid Receptor Antagonists ◽

Long Term Treatment ◽

Real Clinical Practice

In the article is outlined the main concepts use of the mineralocorticoids receptors antagonists in the treatment of congestive heart failure and systolic dysfunction after acute myocardial infarction. Claimed the pivotal role of eplerenone in the long-term treatment strategy due to decrease of mortality and improving the clinical outcomes.

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No-reflow in native coronaries and vein grafts: the role of drugs and distal protection

Oxford Textbook of Interventional Cardiology ◽

10.1093/med/9780198754152.003.0036 ◽

2018 ◽

pp. 557-568

Author(s):

Giovanni Luigi De Maria ◽

Adrian Banning

Keyword(s):

Treatment Strategies ◽

Coronary Intervention ◽

Vein Grafts ◽

No Reflow ◽

Percutaneous Coronary ◽

Long Term Prognosis ◽

Distal Protection ◽

Successful Prevention

Restoration of normal coronary bloodflow and relieving myocardial ischaemia is the main goal of percutaneous coronary intervention (PCI). However, whilst reducing an epicardial coronary stenosis by balloon dilatation may appear to be a relatively easy task, subsequent detrimental changes in bloodflow can paradoxically result in reduced/impaired myocardial perfusion. This condition of mismatch between post-PCI epicardial coronary patency and impaired myocardial reperfusion is defined as slow-flow or no-reflow. It is typically caused by and related to the presence of a damaged, dysfunctional, and/or obstructed coronary microvasculature. When no-reflow occurs, it has an adverse effect on the subsequent mid- and long-term prognosis as it is associated with a higher risk of reinfarction, arrhythmias, heart failure, and a higher in-hospital and long-term cardiac mortality. Frustratingly, nearly four decades after the first PCI, there is still uncertainty about the pathophysiology of no-reflow and a need to define successful prevention and treatment strategies.

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Current Treatment Strategies for Heart Failure: Role of Device Therapy and LV Reconstruction

Current Treatment Options in Cardiovascular Medicine ◽

10.1007/s11936-016-0479-1 ◽

2016 ◽

Vol 18 (9) ◽

Cited By ~ 6

Author(s):

Praneeth Janaswamy ◽

Tomos E. Walters ◽

Babak Nazer ◽

Randall J. Lee

Keyword(s):

Heart Failure ◽

Treatment Strategies ◽

Current Treatment ◽

Device Therapy

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Peripartum Cardiomyopathy: A Review of Three Case Reports

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1204 ◽

2012 ◽

Vol 4 (3) ◽

pp. 164-166 ◽

Cited By ~ 1

Author(s):

Ankita Kumari ◽

Mridul Chaturvedi

Keyword(s):

Heart Failure ◽

Left Ventricular Systolic Dysfunction ◽

Case Reports ◽

Systolic Dysfunction ◽

Signs And Symptoms ◽

Left Ventricular ◽

Peripartum Cardiomyopathy ◽

Idiopathic Cardiomyopathy ◽

Maternal Morbidity And Mortality ◽

Long Term Prognosis

ABSTRACT Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy that presents with heart failure secondary to left ventricular systolic dysfunction toward the end of pregnancy or in the months after delivery. Incidence of PPCM ranges from 1:300 to 1:15,000 pregnancies. Causes and pathogenesis are poorly understood. Clinical presentation includes signs and symptoms of heart failure. PPCM remains a major cause of maternal morbidity and mortality. Many cases of PPCM improve or resolve completely but others progress to heart failure; as early diagnosis and medical treatment may affect the patient's long-term prognosis. The aim of this report is to make health professionals aware of the possibilities in a woman with dyspnoea in the postpartum period. How to cite this article Kumari A, Singh S, Singh S, Chaturvedi M. Peripartum Cardiomyopathy: A Review of Three Case Reports. J South Asian Feder Obst Gynae 2012;4(3):164-166.

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Abstract 156: Enalapril prevents Development of Dilated Cardiomyopathy in Lamin A/C Mutant Mice

Circulation Research ◽

10.1161/res.113.suppl_1.a156 ◽

2013 ◽

Vol 113 (suppl_1) ◽

Author(s):

Abdelaziz Beqqali ◽

Ingrid van Rijsingen ◽

Inge van der Made ◽

Stephanie van den Oever ◽

Yigal Pinto

Keyword(s):

Heart Failure ◽

Cardiac Function ◽

Dilated Cardiomyopathy ◽

Cardiac Fibrosis ◽

Systolic Dysfunction ◽

Treatment Strategies ◽

Mutant Gene ◽

Current Treatment ◽

Response To Treatment ◽

Lamin A

Dilated Cardiomyopathy (DCM) is one of the leading causes of heart failure due to systolic dysfunction. Mutations in the LMNA gene, which encodes the nuclear lamina proteins Lamin A and C, are the most common cause of familial DCM. Current treatment strategies to improve the prognosis are limited to implantable cardioverter-defibrillator and heart transplantation. Patients with LMNA-related DCM are treated in accordance with international guidelines for the management of heart failure with little consideration of the possible influence of the etiology on the response to treatment. Recent studies suggest that this might result in inappropriate therapy in some patients. The influence of genetic factors in determining the response (and timing) of drug therapy is largely unstudied in DCM. Therefore, our aim is to determine the efficacy of existing heart failure drugs in preventing or delaying LMNA-related DCM. We used a well-established mouse model of Lamin A/C mimicking human LMNA-related DCM. Mice heterozygous for the Lmna mutant gene (n=20 per group) were treated with Metoprolol (β-blocker) or Enalapril (ACE-inhibitor) before the onset of DCM and were functionally evaluated by serial echocardiography and ECG until 75 weeks of age. Hearts were harvested for histological analysis and molecular characterization. Interestingly, the experimental group treated with Enalapril had a preserved overall cardiac function comparable to wildtype mice. Mice treated with Metoprolol however, displayed progressive heart failure, and an aggravated cardiac function compared to untreated Lmna +/- mice. Both the beneficial effects of Enalapril in preventing development of systolic dysfunction as well as the detrimental effect of Metoprolol were confirmed by expression of molecular stress markers and degree of cardiac fibrosis. Our results suggest that Enalapril is effective in preventing Lmna+/- induced cardiomyopathy in mice. Strikingly, Metoprolol increases cardiac dysfunction and stress in Lmna+/- mice. Further studies will determine whether Enalapril is also effective in preventing LMNA-related DCM in patients, and whether omitting Metoprolol from the standard cocktail of prescribed heart failure medicine is beneficial for LMNA patients.

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Role of endogenous hydrogen sulfide synthesis gene polymorphisms in the long-term prognosis of patients with ischemic cardiomyopathy related chronic heart failure in Chinese Han population

Nitric Oxide ◽

10.1016/j.niox.2015.02.042 ◽

2015 ◽

Vol 47 ◽

pp. S18

Author(s):

Lan Ren ◽

Zhouying Liu ◽

Xuhua Chen ◽

Xiaoyan Liu ◽

Jielin Pu ◽

...

Keyword(s):

Heart Failure ◽

Hydrogen Sulfide ◽

Chronic Heart Failure ◽

Gene Polymorphisms ◽

Ischemic Cardiomyopathy ◽

Chinese Han ◽

Han Population ◽

Long Term Prognosis

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Peripartum Cardiomyopathy

10.1093/med/9780190226459.003.0045 ◽

2017 ◽

Author(s):

Emily J. Baird

Keyword(s):

Heart Failure ◽

Treatment Strategies ◽

The United States ◽

Current Treatment ◽

Peripartum Cardiomyopathy ◽

Clinical Suspicion ◽

Maternal Deaths ◽

Pregnancy And Lactation ◽

Peripartum Period ◽

Pathophysiologic Mechanisms

Peripartum cardiomyopathy (PPCM) is an idiopathic form of heart failure that manifests during the last month of pregnancy or the first 5 months postpartum. Although the incidence is relatively low, the maternal impact is high, with up to 12% of maternal deaths in the United States resulting from sequelae of PPCM. Risk factors are poorly understood at the present time, as are the pathophysiologic mechanisms. Timely diagnosis continues to be a challenge, since many of the symptoms of PPCM mimic those commonly encountered during the normal peripartum period. Management of PPCM parallels current heart failure guidelines, with special consideration to the safety of medications and interventions during pregnancy and lactation. This chapter discusses proper clinical suspicion, processes for diagnosis, and current treatment strategies as well as the overall prognosis.

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