Weakness of heart muscle and pregnancy – peripartum cardiomyopathy
Heart diseases during pregnancy increase the risk to the mother and sometimes to the baby. Peripartum cardiomyopathy is a rare disease of heart muscle specifically related to pregnancy occurring in the last month of pregnancy or within 5 months after delivery. Peripartum cardiomyopathy is an important cause for severe heart failure in pregnancy and it is due to decreased ability of the left ventricle (lower muscular chamber of the heart) to pump out blood effectively. Usually the recovery is fast after delivery, though some have persistent weakness of heart muscle. Those with persistent weakness of the left ventricular muscle have a high risk of recurrence of the disorder in subsequent pregnancies. There still exists a risk of recurrence in subsequent pregnancies even in those who recover fully. Peripartum cardiomyopathy is treated like any other cause of heart muscle weakness except that delivery of the baby initiates the recovery process. Medicines like digoxin which improves the pumping function of the heart muscle and those which increase the urine output (diuretics) are useful. Medicines which can reduce the work load of the heart like angiotensin converting enzyme inhibitors (e.g. enalapril) can be given once the baby is delivered. Otherwise this group of medicines may produce some defects in the baby. Intravenous medications which improve the pump function of the heart known as inotropes (e.g. dobutamine) are useful to tide over the crisis in an acutely ill patient with peripartum cardiomyopathy.