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CLINICAL COMMENTARY |
From the Departments of Obstetrics and Gynecology, Medicine, and the Committee on Clinical Pharmacology, University of Chicago, Pritzker School of Medicine, Chicago, Illinois.
Address reprint requests to: Judith U. Hibbard, MD Department of Obstetrics and Gynecology University of Chicago 5841 South Maryland Avenue, MC 2050 Chicago, IL 60637 E-mail: jhibbard{at}babies.bsd.uchicago.edu
The diagnosis of peripartum cardiomyopathy is one of exclusion, made after careful search for an underlying cause. Research in this area is compromised by the reliance of some on clinical criteria alone without strict echocardiographic criteria. This article argues for uniform criteria that define peripartum cardiomyopathy, similar to the criteria for idiopathic dilated cardiomyopathy set forth by a National Heart, Lung, and Blood Institute–sponsored workshop and proposes that the new definition include heart failure within the last month of pregnancy or 5 months postpartum; absence of preexisting heart disease; no determinable etiology, the traditional definition; and strict echocardiographic criteria of left ventricular dysfunction: ejection fraction less than 45%, or M-mode fractional shortening less than 30%, or both, and end-diastolic dimension more than 2.7 cm/m2. Mortality from peripartum cardiomyopathy remains high, 25–50%, and a recent review related long-term prognosis to echocardiographic measures of left ventricular chamber dimension and function at diagnosis and recovery. We describe a modified pharmacologic echocardiographic stress test that might be useful in determining left ventricular contractile reserve in women believed to be recovered by routine echocardiographic studies. The test reproduces hemodynamic stress akin to pregnancy, and the data might be useful when counseling women on future childbearing. Women who respond with reduced cardiac reserve might be advised to avoid pregnancy.
This article has been cited by other articles:
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  C L Hu, Y B Li, Y G Zou, J M Zhang, J B Chen, J Liu, Y H Tang, Q Z Tang, and C X Huang Troponin T measurement can predict persistent left ventricular dysfunction in peripartum cardiomyopathy Heart, April 1, 2007; 93(4): 488 - 490. [Abstract] [Full Text] [PDF]
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 J. B. Chapa, H. B. Heiberger, L. Weinert, J. DeCara, R. M. Lang, and J. U. Hibbard Prognostic Value of Echocardiography in Peripartum Cardiomyopathy Obstet. Gynecol., June 1, 2005; 105(6): 1303 - 1308. [Abstract] [Full Text] [PDF]
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A mother's heartache: peripartum cardiomyopathy Heart, April 1, 2005; 91(4): 552 - 552. [Full Text] [PDF]
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 P. Ray, G. J. Murphy, and L. E. Shutt Recognition and management of maternal cardiac disease in pregnancy Br. J. Anaesth., September 1, 2004; 93(3): 428 - 439. [Abstract] [Full Text] [PDF]
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S. J. Whitehead, C. J. Berg, and J. Chang Pregnancy-Related Mortality Due to Cardiomyopathy: United States, 1991-1997 Obstet. Gynecol., December 1, 2003; 102(6): 1326 - 1331. [Abstract] [Full Text] [PDF]
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 M. Lasinska-Kowara, M. Dudziak, and J. Suchorzewska Two cases of postpartum cardiomyopathy initially misdiagnosed for pulmonary embolism : [Deux cas de cardiomyopathie du postpartum diagnostiques d'abord comme embolie pulmonaire] Can J Anesth, September 1, 2001; 48(8): 773 - 777. [Abstract] [Full Text] [PDF]
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 S. C. Reimold and J. D. Rutherford Peripartum Cardiomyopathy N. Engl. J. Med., May 24, 2001; 344(21): 1629 - 1630. [Full Text] [PDF]
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