**5. Etiopathology**

*Inflammatory Heart Diseases*

Zaria syndrome.

**2. Definition**

contains the following characteristics:

0.45 with or without LV dilatation [2]

the geographic and dietary variabilities [5].

2.Multiparty, African descent [7].

3.Maternal cocaine abuse [8].

in postpartum period

**3. Epidemiology**

**4. Risk factors**

is still not clear.

of heart disease, and there are no other known possible causes of heart failure (HF). Echocardiogram is essentially used for both diagnosis and monitoring purposes in the progress of PPCM. Although initially described in the 18th century, it was recognized as distinct clinical in 1930, and Demakis et al. described and defined PPCM [1]. PPCM was initially termed as pregnancy-associated cardiomyopathy, toxic postpartum heart failure, Meadows' syndrome, postpartum myocarditis, and

There are varieties of definitions for PPCM; the more simplified one is by the working group on peripartum cardiomyopathy from the European Society of Cardiology in 2010. It avoids under diagnosis by adopting a broader definition. It

1.The development of heart failure in last month of pregnancy or up to 5 months

3.Systolic dysfunction of left ventricle (LV) and LV ejection fraction of less than

PPCM constitutes less than 1% of all cardiovascular events related to pregnancy. It is more common in Africa, 1:300 pregnancies. This may be due to the consumption of kanwa, a tradition, for 40 postpartum days. Kanwa is a dry salt and causes hypervolemia and hypertension. Ninety percent of PPCM occurs within 2 months of delivery [3]. In a recently concluded study about the incidence of PPCM from 43 countries, affecting females from all ethnicity and all continents, the incidence widely differs depending on geographic location. PPCM was common in Nigeria (1100), Haiti (1300), South Africa (11,000), Canada (12,400), and Denmark (110,149) and was lowest in Japan (1,20,000 live births). There are case reports from other countries [4]. Hence the information is not complete as many countries are not having a registry. The higher incidence in Nigeria may be related to abovementioned postpartum high salt intake or may be a genetic factor superimposing

The following are the risk factors for PCCM, even though the etiology of PPCM

1.Age over 30 years, pregnancy with multiple fetuses [6].

2.Absence of another known or identifiable cause for heart failure

**110**

In the pathology of peripartum cardiomyopathy, the macroscopic view is a pale myocardium, dilated heart often with intramural thrombus in the ventricles. There will be endocardial thickening and pericardial effusion. The myocardial cellular hypertrophy and myofibril degeneration with areas of fibrosis with interstitial edema are the nonspecific findings. In a small group of patients, there are features of myocarditis with the presence of inflammatory cell infiltration of myocardium, focal necrosis, variable hypertrophy, and fibrosis of the myocardium [11].

Although PPCM is a separate clinical entity, the exact etiology of PPCM is still not known. Following hypothesis had been proposed for the etiology.
