**7.1. Signs and symptoms**

The patients usually present with sign and symptoms of heart failure: dyspnea, fatigue, and peripheral oedema. In early stages, these signs may mimic the presenting features of normal late pregnancy.

Echocardiography may show new onset of unexplained LV dysfunction and documentation of a new finding of dilated cardiac chambers with LV systolic dysfunction during the period surrounding parturition.

#### **7.2. Treatment**

The main aim of treatment is to relieve the symptoms of heart failure. Diuretics, vasodilators, and digoxin can be used effectively. During pregnancy, vasodilation is accomplished with hydralazine and nitrates. Intravenous immunoglobulin may have a beneficial effect. Thromboembolic complications are not uncommon, and anticoagulation may be required in most patients. Heart transplantation may be considered in patients who do not improve over time.
