**7. Peripartum cardiomyopathy**

Peripartum cardiomyopathy is a rare, dilated form of cardiomyopathy of unknown cause that occurs during the peripartum period, that is, the third trimester of pregnancy until 5 months after delivery. Peripartum cardiomyopathy (PPCM) is a major concern for anaesthetists and can occur in 1 in 10,000 pregnancies, but it is higher in subsequent pregnancies [8]. Patients may present with severe heart failure during the third trimester or up to 5 months postpartum. Many of these patients deliver via a normal vaginal delivery without complications; however, a few may require a Caesarean section.

**7.3. Prognosis**

anaesthetists.

of CAD.

**8.1. Sign and symptoms**

**7.4. Anaesthetic management**

good postoperative analgesia.

**8. Takotsubo cardiomyopathy**

The mortality in this group of patients is as high as 30–60% due to pulmonary oedema and systemic embolisation with most deaths occurring mostly within 3 months of delivery.

Current Perspectives on Cardiomyopathies http://dx.doi.org/10.5772/intechopen.79529 121

We have a very little literature regarding the anaesthetic management of PPCM yet. Optimum fluid management and avoiding myocardial depression are the major concerns for

According to a few case reports, both general anaesthesia and neuraxial blocks have been successfully used for elective or emergency Caesarean section. Combined spinal epidural anaesthesia (CSE) is preferred by some. CSE causes less haemodynamic instability, has a higher success rate than epidural anaesthesia, results in better patient satisfaction, and provides

Recently, Takotsubo cardiomyopathy has been described. Takotsubo cardiomyopathy is a rare condition of transient, reversible severe LV dysfunction and characterised by chest pain, dyspnoea, ST-T changes in ECG, ventricular arrhythmias, regional wall motion abnormalities on echocardiography, elevated cardiac enzymes, haemodynamic instability, pulmonary oedema, cardiogenic shock, or cardiac arrest without angiographic evidence

It is rare, usually occurs in postmenopausal women associated with stress and chest pain. ECG changes may include prolonged QTc interval which resolve in 1–2 days, ST-T changes, Q

This condition is also known as apical ballooning syndrome and broken heart syndrome or stress-induced cardiomyopathy. Echocardiography shows akinesia of apical or midventricular segments leading to systolic dysfunction. The normal basal segments become hypercontractile, giving a ballooned-out appearance of the apical or mid-cavity segments. Ballooning may lead to altered spatial relationships between mitral leaflets and subvalvular apparatus,

Reversible myocardial ischaemia is seen on myocardial perfusion imaging, and positron emission tomography and magnetic resonance imaging confirm LV dysfunction. Biopsy may show lymphocytic infiltrates. Plasma levels of brain natriuretic peptide, catecholamines, car-

waves, resolve by discharge from hospital, and T inversion resolves slowly.

which may result in MR and dynamic LVOTO causing SAM.

diac enzymes and metanephrine are found to be elevated.

**Risk factors** include maternal age > 30 years, multiparty, African descent, obesity, multiple pregnancy, hypertensive disorders, tocolytic therapy, viral infection, and cocaine use.

**Diagnostic criteria of peripartum cardiomyopathy:** The diagnosis of PPCM is usually made after the other causes of acute heart failure have been excluded. The criteria are:

