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Correspondence to Author: Jayesh Trivedi¹, Virendra Kumar Goyal²,Sohail³, Priya Kunwar⁴, Shubham Balki⁵, Keyur Soni⁵, Ayushya Pal Singh⁵, Sudeep Deswal ⁵, Shweta Pandey⁵, Harjeet kaur⁵, Simran kajla⁵, Himanshu Yadav⁵, Raja Joshi⁵. 

1. Professor Department of Internal Medicine Pacific Medical College & Hospital, Udaipur.
2. Professor & Head of Department of Internal Medicine Pacific Medical College & Hospital, Udaipur.
3. Assistant Professor, Department of Internal Medicine Pacific Medical College & Hospital, Udaipur.
4. Senior Resident, Department of Internal Medicine Pacific Medical College & Hospital, Udaipur.
5. Post Graduate Residents, Department of Internal Medicine Pacific Medical College & Hospital, Udaipur.

DOI: 10.52338/tjoht.2025.4774

Abstract:

Peripartum cardiomyopathy (PPCM) is an uncommon yet life-threatening form of heart failure occurring towards the end of pregnancy or in the months following delivery in women with no prior heart disease . It is characterized by left ventricular systolic dysfunction (often with an ejection fraction <45%) arising in the peripartum period without other identifiable causes . PPCM typically presents with symptoms of heart failure – such as dyspnea, orthopnea, edema, and fatigue – which can be mistaken for normal peripartum changes, leading to potential delays in diagnosis . The etiopathogenesis remains incompletely understood; proposed mechanisms include a “two-hit” model of pregnancy-induced hemodynamic stress or hormonal insult (e.g. cleavage of prolactin into cardiotoxic fragments) superimposed on an underlying genetic or microvascular vulnerability . Prompt diagnosis relies on a high index of suspicion and confirmation by echocardiography demonstrating reduced ejection fraction, alongside exclusion of other causes of cardiac failure. Management requires a multidisciplinary approach and is centered on guideline-directed heart failure therapy tailored to pregnancy and lactation, including beta-blockers, vasodilators, diuretics, and anticoagulation when indicated . In severe cases, advanced therapies such as bromocriptine (to halt prolactin release) , mechanical circulatory support, or cardiac transplantation may be necessary. With timely treatment, the prognosis has improved: many patients experience substantial recovery of cardiac function within 6–12 months , though a subset suffer persistent cardiomyopathy or relapse with subsequent pregnancies. This review provides an in-depth overview of PPCM, including current insights into its epidemiology, pathophysiology, clinical presentation, diagnostic criteria, and state-of-the-art management strategies, with emphasis on recent guidelines and outcomes data relevant to specialist care.

Citation:

Jayesh Trivedi, Peripartum Cardiomyopathy (PPCM) – A Comprehensive Review. The European Journal of Cancer 2025.