Peripartum Cardiomyopathy (PPCM)

Peripartum cardiomyopathy (PPCM), also known as postpartum cardiomyopathy, is an uncommon form of heart failure that develops toward the end of pregnancy or within several months of giving birth.

Cardiomyopathy refers to a weakening of the heart muscle. The heart chambers may enlarge and there is a decrease in the percentage of blood ejected from the heart with each contraction (also called the ejection fraction). This can lead to a backup of fluid in the lungs (causing shortness of breath) or legs (causing swelling).

In severe situations, the heart may not be able to meet the demands of the body's organs for oxygen, affecting the lungs, liver and other body systems. For women with severe PPCM, a heart device may be needed to support the weakened heart muscle or a heart transplant may be required. View or Download Pacemakers & Defibrillators PDF.

PPCM Risk Factors

For these reasons, Michigan Medicine combines the expertise of obstetricians and cardiologists to treat and manage patients and to monitor their risks. High blood pressure, preeclampsia, diabetes, older age, and African American race are associated with the development of peripartum cardiomyopathy, but many patients do not have risk factors.

Symptoms

Peripartum cardiomyopathy (PPCM) symptoms may include:

  • Fatigue
  • Shortness of breath
  • Swollen ankles and feet
  • Weight gain
  • Waking up at night with shortness of breath
  • Shortness of breath that occurs when laying flat
  • Heart palpitations or a rapid heartbeat
  • Chest pain

Diagnosis

Peripartum cardiomyopathy can be difficult to diagnose because some of the symptoms — swelling, fatigue and fluid retention — are normal during pregnancy, but are  also symptoms of heart disease. Tests to diagnose PPCM may include:

  • Blood tests
  • Chest X-ray
  • Echocardiogram

Treatment

Peripartum cardiomyopathy patients are sometimes hospitalized until their symptoms are managed. PPCM is treated with similar medications used for other forms of heart failure. However, women should consult with their doctor about which medications are safe during pregnancy and compatible with breastfeeding.

Diuretics (“water-pills”) can relieve fluid retention and swelling. Beta-blockers and ACE inhibitors can help the heart beat more efficiently, but ACE inhibitors cannot be used until after pregnancy. Women with PPCM may also need to follow a low-salt diet to manage their blood pressure.

Because peripartum cardiomyopathy causes irreversible heart damage, an artificial heart pump or heart transplant may be needed, but this is rare.

Women with PPCM have a significant risk of recurrent heart failure and other complications if they become pregnant again.

Any woman who has been diagnosed with peripartum cardiomyopathy should consult with her cardiologist and obstetrician to discuss potential risks prior to having another pregnancy. Also, women who have had PPCM should see a cardiologist on a regular basis to monitor heart function and discuss ongoing use of medications.

Treating PPCM at Michigan Medicine

The Michigan Medicine cardio-obstetrics team includes experts in maternal fetal medicine, adult congenital heart disease, cardiology, nursing, pharmacy and anesthesiology — all dedicated to treating and managing patients properly while providing the necessary support.

In recent years, our cardio-obstetrics expertise has expanded from caring for women who have existing heart disease to treating a wider range of prenatal and postpartum patients.

Our cardio-obstetrics team meets regularly to discuss the health of patients during and after pregnancy to determine a care plan. The goal is for obstetricians and cardiologists to work together to ensure a comprehensive plan for each individual patient.

Physicians at Michigan Medicine are also actively involved in peripartum cardiomyopathy research. One area of focus is on whether breastfeeding impacts the recovery of the heart. Another is on different blood tests and biomarkers that may identify women at risk for PPCM.

Make an Appointment

To make an appointment to discuss your risk for PPCM, contact the Frankel Cardiovascular Call Center at 888-287-1082 or visit our Make a Cardiovascular Appointment page to find out more about what to expect when you call.