**7.3. Prognosis**

• Early placement of an ICD may be lifesaving.

however, a few may require a Caesarean section.

• Absence of another identifiable cause of cardiac failure

**7.1. Signs and symptoms**

surrounding parturition.

late pregnancy.

**7.2. Treatment**

• Absence of cardiac symptoms or disease before late pregnancy

**7. Peripartum cardiomyopathy**

120 Current Topics in Intensive Care Medicine

• In some exceptional cases, heart transplantation may be required.

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;

**Risk factors** include maternal age > 30 years, multiparty, African descent, obesity, multiple

**Diagnostic criteria of peripartum cardiomyopathy:** The diagnosis of PPCM is usually made

• Heart failure developing towards the end of pregnancy or up to 5 months' postpartum

• Left ventricular dysfunction - defined as an EF <45% or reduced fractional shortening of <30%

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

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

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.

pregnancy, hypertensive disorders, tocolytic therapy, viral infection, and cocaine use.

after the other causes of acute heart failure have been excluded. The criteria are:

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.

#### **7.4. Anaesthetic management**

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 anaesthetists.

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 good postoperative analgesia.
