2. In the name of God

3. Peripartum cardiomyopathy Dr. Minoo Movahedi

4. Peripartum cardiomyopathy Dr. Minoo Movahedi

5. Definition : - Heart failure end of pregnancy months after delivery
Definition : - Heart failure end of pregnancy months after delivery . -Absence another cause for HF - Left ventricular ststolic dysfunction EF < 45%

6. Epidemiology : USA : 1/4000 live birth Nigeria & Zaria : 1/100

7. Etiology : Unknown * * Multifactoria - Angiogenic imbalance during late pregnancy : placenta : VEGF inhibitors damage vascular High level : PIH – multiple gestation

8. Role of prolactin : prolactin : 16 KDa isoform Antiangiogenic & proapoptose endothelial damage

9. Inflammatory cytokins : ( TNF) alpha interlokin 6 CRP : more severe disease

10. - Myocarditis : diffuse patchy prednisone & Azathiopirine - Abnormal immune response : Fetal antigen auto antibodies - Genetic predisposition :

11. - Hemodynamic factors : % blood volume - Risk factors age > 30 years multiple fetuses PIH cocaine abuse oral tocolytic therapy with Beta agonist Selenium deficiency African American race

12. Clinical manicfestations : - Time : late pregnancy (38w) & post partum early onset ( 32 w )

13. Symptoms & signs : fatigue dyspnea cough orthopnea pedal edema hemoptysis elevated JVP third heart sound murmur of MR signs of thromboembolism

14. Diagnosis : EKG BNP chest X Ray Echocardiography CMRI cardiac catheterization Endomyocardial Biopsy

15. Differential Diagnosis : other cardiomyopathy MI Pulmonary embolus

16. Management : Oxygen & ventilation treatment of HF Arrhythmia management ICD Antithrombotic therapy mechanical circulatory support cardiac transplantation

17. Bromocriptine : 2. 5 mg twice daily / 2 weeks 2
Bromocriptine : 2.5 mg twice daily / 2 weeks 2.5 mg daily / 6 weeks Immunosuppressive agents : IVIG

18. Delivery : Maternal & fetal conditions C/S 40% Preterm labor : 25%
SGA : 6%
Breast feeding :
Risk - benefit
Contraception :
IUD TL

19. Maternal out come : NYHA class III , IV LVEF ≤ 25 % Black race Indigent status Multiparity Age > 30 to 35 years

20. Subsequent pregnancy : Recovered LV function Recurrence Develope HF Persistent LV dysfunction : LV EF < 50 Atdiagnosis LVEF ≤25 HF Death Preterm delivery Therapeutic abortion

21. Thanks for attention