emDocs - July 4, 2019 - By Rometti M and Patti L
Edited by: Montrief T, Koyfman A and Long B
"Take Home Points
- The highest risk for PPCM is in the month prior and the five months following delivery. Diagnosis includes heart failure within this timeframe with no other known underlying etiologies.
- Consider this diagnosis in patients who are presenting with dyspnea on exertion or other signs of heart failure. Be wary of confusing these with common symptoms of late pregnancy.
- Initial management should evaluate and support the patient’s respiratory status, with oxygen supplementation and consideration of non-invasive or invasive ventilation as dictated by the stability of the patient, as well as consideration of nitroglycerin (preload) and diuretics (systemic congestion). Patients in cardiogenic shock require resuscitation with vasopressors, inotropes, and consideration of ventricular assist devices.
- In the still pregnant patient, consider early fetal monitoring in order to evaluate for uterine perfusion.
- In the pregnant patient, avoidACE-Is, ARBs, warfarin, and DOACs for concern for teratogenicity. These are acceptable in the post-partum patient."