Peripartum Cardiomyopathy

Peripartum cardiomyopathy (PPCM) is a life-threatening condition defined as heart failure with reduced ejection fraction (typically LVEF below 45%) developing in the last month of pregnancy or within 5 months after delivery, in the absence of another identifiable cause. The pathophysiology involves multiple mechanisms including a 16-kDa prolactin fragment that is cardiotoxic, autoimmune processes involving beta-1 adrenergic receptor autoantibodies, and genetic susceptibility (particularly TTN gene variants). The disease ranges from mild heart failure that resolves completely to severe cardiomyopathy requiring mechanical circulatory support or heart transplantation. About 50% of patients recover normal ventricular function, typically within 6 months. However, recovery is not guaranteed, and some women develop progressive dilated cardiomyopathy. Subsequent pregnancies carry significant recurrence risk (30-50%), especially in women who did not fully recover. Standard heart failure medications form the backbone of treatment, with modifications for breastfeeding. The discovery of autoantibody-mediated pathways has opened new therapeutic avenues.