**8.2 Brain natriuretic peptide (BNP)**

Plasma BNP or pro-BNP (proBNP) measurement is helpful in the evaluation and diagnosis of patients with heart failure. Patients with PPCM have increased BNP and NT-proBNP levels, higher than seen in healthy women during pregnancy or postpartum.

#### **8.3 Chest X-rays**

Commonly it will show enlargement of the cardiac silhouette with pulmonary congestion and/or interstitial edema and pleural effusions. However, a chest radiograph is not necessary to make a diagnosis of HF or PPCM and exposes the patient to ionizing radiation.

#### **8.4 Echocardiography (echo)**

Echocardiogram is essential in the diagnosis of PPCM; it reveals a global reduction in LV systolic function with LVEF of < 45%. Left ventricle is commonly but not always dilated. Assessment of right ventricular systolic pressures can be performed (**Figure 3**). Echo may show presence of left atrial thrombus, dilated right ventricle, abnormal ventricular wall motion, mitral and tricuspid regurgitation, and pericardial effusion.

#### **8.5 Cardiac magnetic resonance imaging (CMR)**

If echocardiography is technically suboptimal, CMR can help. It helps in assessing LV function and LV volumes. Experience with CMR in PPCM is limited and its role is still being evaluated.

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*Peripartum Cardiomyopathy: Facts and Figures DOI: http://dx.doi.org/10.5772/intechopen.85718*

**8.6 Cardiac catheterization**

*regurgitation view of PPCM.*

**Figure 3.**

patients with suspected PPCM.

**9. Differential diagnosis**

**8.8 Endomyocardial biopsy (EMB)**

ongoing evaluation of their hemodynamic state.

**8.7 Left heart catheterization and coronary angiography**

It may be helpful in critically ill patients, requiring a complete assessment or

*Four chamber view of PPCM A: Echocardiographic four chamber view of PPCM. B: Echocardiogrhic Mitral* 

It is required in selected patients in whom it is necessary to evaluate coronary artery disease as a potential cause for the cardiomyopathy. The coronary angiography exposes the patient to ionizing radiation and it is commonly not required in

EMB is recommended in clinical scenarios in which a biopsy is anticipated to yield a diagnosis of a specific condition with treatment implications. These scenarios include heart failure with hemodynamic compromise of less than 2 weeks duration or heart failure of less than 3 months duration if associated with heart block, new ventricular arrhythmias, or refractory heart failure. EMB is not recommended for the routine evaluation of heart failure, as there are no pathognomonic findings in PPCM. The

PPCM should be differentiated from other forms of cardiomyopathy (**Figure 4**), heart failure, pulmonary thromboembolism, severe eclampsia, and pneumonia. From history, in physical examination and investigations, one must exclude myocardial infarction, idiopathic dilated cardiomyopathy, and valvular heart disease [9].

risk of a serious acute complication is less than 1% using flexible bioptomes.

*Peripartum Cardiomyopathy: Facts and Figures DOI: http://dx.doi.org/10.5772/intechopen.85718*

**Figure 3.**

*Inflammatory Heart Diseases*

**8.1 Electrocardiogram (ECG)**

**8.2 Brain natriuretic peptide (BNP)**

postpartum.

**8.3 Chest X-rays**

to ionizing radiation.

dial effusion.

**8.4 Echocardiography (echo)**

role is still being evaluated.

**8.5 Cardiac magnetic resonance imaging (CMR)**

As mentioned initially diagnosis of PPCM based on three clinical criteria, development of heart failure in last month of pregnancy or in the initial 5 months following delivery with the absence of another identifiable cause of HF and left ventricular (LV) systolic dysfunction with an left ventricular ejection fraction (LVEF) of < 45%. The last criteria will exclude patients with accelerated hypertension, diastolic dysfunction, systemic infection, pulmonary embolism, or preeclampsia or amniotic fluid embolus. Chest X-ray, electrocardiogram (ECG), and echocardiogram should be performed in patients who are clinically suspected of having PPCM. Studies showed brain natriuretic peptide (BNP) levels, cardiac magnetic resonance (CMR) imaging, cardiac catheterization, and endomyocardial biopsy (EMB) will be helpful in these patients. Bacterial cultures and viral titers are usually not indicated, as these tests are nonspecific and without proven value in patients with myocarditis. The novel markers, plasma concentrations of proangiogenic and antiangiogenic factors, placenta growth factor, and fms-like tyrosine kinase 1 receptor,

have been proposed to be used to distinguish patients with PPCM [22].

diagnosis such as myocardial infarction and pulmonary embolism [1].

It is not specific in PPCM patients and may show sinus tachycardia rarely arrhythmias and nonspecific ST segment and T wave changes. PR and QRS intervals may be prolonged. An ECG is helpful in identifying conditions in the differential

Plasma BNP or pro-BNP (proBNP) measurement is helpful in the evaluation and diagnosis of patients with heart failure. Patients with PPCM have increased BNP and NT-proBNP levels, higher than seen in healthy women during pregnancy or

Commonly it will show enlargement of the cardiac silhouette with pulmonary congestion and/or interstitial edema and pleural effusions. However, a chest radiograph is not necessary to make a diagnosis of HF or PPCM and exposes the patient

Echocardiogram is essential in the diagnosis of PPCM; it reveals a global reduction in LV systolic function with LVEF of < 45%. Left ventricle is commonly but not always dilated. Assessment of right ventricular systolic pressures can be performed (**Figure 3**). Echo may show presence of left atrial thrombus, dilated right ventricle, abnormal ventricular wall motion, mitral and tricuspid regurgitation, and pericar-

If echocardiography is technically suboptimal, CMR can help. It helps in assessing LV function and LV volumes. Experience with CMR in PPCM is limited and its

**8. Diagnosis**

**114**

*Four chamber view of PPCM A: Echocardiographic four chamber view of PPCM. B: Echocardiogrhic Mitral regurgitation view of PPCM.*

#### **8.6 Cardiac catheterization**

It may be helpful in critically ill patients, requiring a complete assessment or ongoing evaluation of their hemodynamic state.

#### **8.7 Left heart catheterization and coronary angiography**

It is required in selected patients in whom it is necessary to evaluate coronary artery disease as a potential cause for the cardiomyopathy. The coronary angiography exposes the patient to ionizing radiation and it is commonly not required in patients with suspected PPCM.

#### **8.8 Endomyocardial biopsy (EMB)**

EMB is recommended in clinical scenarios in which a biopsy is anticipated to yield a diagnosis of a specific condition with treatment implications. These scenarios include heart failure with hemodynamic compromise of less than 2 weeks duration or heart failure of less than 3 months duration if associated with heart block, new ventricular arrhythmias, or refractory heart failure. EMB is not recommended for the routine evaluation of heart failure, as there are no pathognomonic findings in PPCM. The risk of a serious acute complication is less than 1% using flexible bioptomes.
