What is the etiology of peripartum cardiomyopathy? The etiology is unknown; multiple etiologies have been proposed. The most substantiated etiology is viral myocarditis.. It is thought that the relative immunosuppression of pregnancy may increase the risk of viral myocarditis (JEM, V. 36, pg. 141). Differential includes hypertensive pulmonary, mobilization of volume following delivery, pulmonary embolism, and pneumonia. the workup involves an echocardiogram to demonstrate decrease systolic function and exclusion of other causes. The mainstay of treatment is afterload reduction (nitroprusside) and diuretics.
Peripartum cardiomyopaty is more complex than that. It involves a complex path with defective antioxidant mechanisms. Oxidative stress leads to increase in cathepsin D which cleaves prolactin which leads to increased pro-apoptotic factors. So besides routine CHF meds as mentioned above you can also give bromocriptine to suppress prolactin production – but give it with anticoagulants because of theoretical risk of increased clots formation. IVIG for immune modulation and pentoxifyline which inhibits TNF-alpha production have also been shown to increase EF. Avoid breastfeeding to keep prolactin low.
Multiple etiologies postulated and the most significant is autoimmune mediate. The recovery rate (35%)would rule out viral myocarditis as the usual cause…