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Providers Weigh In: What Expecting Mothers Need to know

Wednesday, April 15, 2015

Joan Briller
Joan Briller, M.D.
Cardiologist at UI Health

Most women think of their due date as something magical. Going into the home stretch is a time of excitement and nerves, but the countdown to motherhood has begun! The last trimester can bring some unpleasant physical changes. Mothers tend to dread the anticipated symptoms their last trimester of pregnancy brings, but there is a serious disease at hand that can disguise itself alongside those normal pregnancy side effects.

Peripartum Cardiomyopathy (PPCM) is heart failure that occurs in women who are near the end of their pregnancy or women with heart failure up until 4-5 months after their delivery. As normal physiologic changes of pregnancy can mimic heart failure symptoms, patients and their physicians may think that everything is normal and diagnosis of heart failure can be missed. These symptoms include:

  • Shortness of breath and coughing that generally occur at night (Paroxysmal Nocturnal Dyspnea) 
  • Difficult or uncomfortable breathing on exertion (Dyspnea on exertion) 
  • Cough 
  • Shortness of breath on when lying flat, causing the person to have to sleep propped up in bed or sitting in a chair.(Orthopnea) 
  • Swelling (edema) above and below the knee 
  • Abdominal pain or chest pain 
  • Palpitations – awareness of heart beating 
  • Pink sputum

Source: myheartsisters.com

While PPCM is not common, most women are unaware of it and the symptoms overlap with normal pregnancy can make it more difficult to diagnose. “Many cases of PPCM are diagnosed late after complications have occurred such as, ICU admission, serious rhythm disturbances, cardiac arrest, or clot from formation or strokes,” says Dr. Joan Briller Cardiologist of UI Health. “We can confirm or rule out the diagnosis with an echocardiogram and blood work.”

Currently therapy for PPCM uses medications used to treat heart failure which may be modified if the woman is still pregnant, but research is underway to better under the cause and asses potential new treatments. Many women make a full recovery, and PPCM has excellent outcomes if treated early. Delays in treatment can lead to disability and death underlining the need for women and their health care providers to be vigilant.