Cardiomyopathie du péripartum

Peripartum cardiomyopathy is defined as the occurrence of congestive cardiac failure during or after pregnancy with left ventricular dysfunction and no other cause documented although immunological and hormonal factors could be implicated. The incidence ranges between 1/1000 and 1/4000 deliveries. The typical clinical picture is that of a rapidly progressing cardiac failure. Echocardiography makes the diagnosis, the prognosis and monitors the evolution. Due to the severity of the disease, its rapid evolution, the possibility of intractable cardiac shock during the first 48 hours, patients should be placed in cardiac ICU where extracorporeal assistance is feasible. Blockers of rennin-angiotensin system are contra-indicated, otherwise cardiac failure treatment is not specific. Anticoagulation is required due to the risk of intracardiac thrombosis. When the evolution is extremely rapid and cardiac biopsy documents an inflammatory process, immunosuppressive therapy could be indicated. Bromocriptin has been documented to improve morbidity and mortality in a small series of patients. Complete recovery occurs in 50% of the case while the other half may suffer from more or less severe cardiac failure.