Treatment of peripartum cardiomyopathy, a rare and often lethal disorder of unknown origin, requires dose collaboration among specialists in cardiology, obstetrics, and perinatology, Dr. Gail D. Pearson and her associates said.
The diagnosis of peripartum cardiomyopathy requires echocardiographic identification of new left ventricular systolic dysfunction during the peripartum period, they said in the summary report of a multidisciplinary workshop on the disorder.
"This presents a challenge because many women in the last month of a normal pregnancy experience dyspnea, fatigue, and pedal edema, symptoms identical to early congestive heart failure," said Dr. Pearson of the National Heart, Lung, and Blood Institute, Bethesda, Md., and her associates.
ACE inhibitors should be avoided during pregnancy but are the mainstay of therapy if the baby has been delivered.
Safe alternatives before delivery include hydralazine and nitrates. Diuretics, vasodilators, and digoxin should be used as needed, they said (JAMA 283[9]:1183-88, 2000).
[Beta]-adrenoreceptor antagonists can be used in the postpartum period if patients continue to have left ventricular compromise after 2 weeks of standard heart failure management. Those with severe heart failure may require hospitalization and more aggressive support, including intravenous inotropic agents, oxygen, and invasive monitoring.
Women with significantly depressed left ventricular function may benefit from anticoagulation therapy--heparin before delivery and warfarin afterward--to prevent thrombosis and emboli. Immunosuppressive therapy can be considered if myocarditis fails to improve after 2 weeks. Those who fail maximal medical management may be candidates for cardiac transplantation.
COPYRIGHT 2000 International Medical News Group
COPYRIGHT 2001 Gale Group
Contact
Home
A
Arthritis