Peripartum cardiomyopathy: An update

Peripartum cardiomyopathy is a rare and potentially devastating condition that can be difficult to recognize. We review here progress in the past decade on its epidemiology, pathogenesis, diagnosis, management, and prognosis. Incidence appears to be increasing, and African-American women are disproportionately affected. New data from animal models and human studies provide insight into mechanisms and potential new therapeutic targets, including abnormal intracellular signaling, apoptosis, anti-angiogenic pathways, and anti-inflammatory pathways. Peripartum cardiomyopathy has now been diagnosed earlier in pregnancy than previously reported. Echocardiographic criteria for diagnosis have been refined, but an accurate diagnosis still relies on a high index of suspicion and considering a broad differential diagnosis. Management options have expanded as advances have been made in heart failure therapy generally, but options are constrained when managing heart failure before delivery. The prognosis has improved considerably, with mortality rates lower than 5% now reported. Potential new strategies for predicting ventricular recovery are available.