Peripartum cardiomyopathy: risk factors, hospital course and prognosis; experiences at Lady Reading Hospital Peshawar

Ibrahim Shah^1*, Shahzeb², Mohammad Hafizullah³, Syed Tahir Shah⁴, Mohammad Faheem⁵,  Rafiullah⁶

¹FCPS (Cardiology) Resident, Department of Cardiology  Postgraduate Medical Institute Lady Reading Hospital Peshawar.

²Resident, Department of Cardiology, Postgraduate Medical Institute, Lady Reading Hospital Peshawar.

³FRCP, FCPS (Cardiology), FACC, SCAI Fellowship (USA) Professor, Head of Department and VC KMU, Department of Cardiology   Postgraduate Medical Institute, Lady Reading Hospital Peshawar.

⁴Resident, Department of Cardiology, Postgraduate Medical Institute, Lady Reading Hospital Peshawar.

 ⁵Senior registrar, Department of Cardiology, Postgraduate Medical Institute, Lady Reading Hospital Peshawar.

⁶Resident, Department of Cardiology, Postgraduate Medical Institute, Lady Reading Hospital Peshawar.

*Corresponding Author E-mail: cardiol2011@yahoo.com; Tel: 03339113365

Accepted 01 September, 2012

Abstract

To study the so-called risk factors associated with peripartum cardiomyopathy, its hospital course, short and long term mortality and outcome of subsequent pregnancies. A total of 61 patients diagnosed   with peripartum cardiomyopathy were enrolled in the study. Data regarding risk factors, presenting complaints, complications, pregnancy outcomes, therapeutics used and outcome at 3, 6 and 12 months were recorded. The incidence was estimated to be 1 per 933 deliveries. Mean age ±SD was 30.94±6.63 years. Majority of patients 33(54.1%) were obese. The mean parity was 3.66 ±1.41. Other risk factors were chronic hypertension 19 (31.1%), pre-eclampsia 12 (19.7%), multiple pregnancies 5(8.2%), long term tocolysis 13 (21.3%) and anemia 21(34.4%). Forty-three patients 43(70.5%) presented in post partum period while 18 (29.5%)    in atepartum period. Majority of patients presented with dyspnea and were in NYHA class ІІІ 18(29.5%) &IV 35(57.5%). Main ECG findings were sinus tachycardia 39 (63.9%), LV hypertrophy 42 (68.9%), T wave inversion 28(45.9%) and Poor R wave progression in precordial leads with Q waves 40(65.6%). Ejection fraction was universally reduced. Other echocardiograpic findings included chamber dilation 48(78.7%), moderate to severe mitral regurgitation 15(24.6%), left ventricular thrombus 12 (19.7%) and pulmonary artery hypertension 15(24.6%). Thirty-six women 36(59%) had normal vaginal delivery, 12(19.7%) had assisted vaginal delivery and 13(21.3%) required caesarean section. There were 50(82%) live births and 11(18%) perinatal deaths. The main complications were pulmonary edema 7(11.5%), cardiogenic shock 8(13.1%) and thromboembolism 13(21.3%). At hospital discharge, 9 (14.8%) patients were dead and 52(85.2%) were discharged with stable heart failure. Major therapeutics used was various drugs used in the treatment of heart failure and specialized therapies including implantable cardiac defibrillator (ICD) 5(8.2%)), cardiac resynchronization therapy (CRT) 3(4.9%)) and cardiac transplantation or left ventricular assist device 8(13.1%)). At the last follow up at month 12, total of   20(32.8%)) were dead while 32(52.5%)) had recovered fully and 9(14.75%)) were still suffering from heart failure. During follow up, only 8 (19.5) pregnancies were detected. Five 5(62.5) patients had uneventful course while two 3(37.5) developed heart failure again. Peripartum cardiomyopathy is associated with multiple risk factors and carries high morbidity and mortality.

Keywords: Peripartum cardiomyopathy, Risk factors, Hospital course, Prognosis.