**10. Management**

The therapeutic approach of PPCM is the same as for other types of HF with left ventricular systolic dysfunction. Precautions should be taken to ensure the safety of the mother and the unborn or breastfeeding child; these patients may need antiarrhythmic drugs, anticoagulation therapy, mechanical support, and the use of investigational medications (bromocriptine).

The cornerstone in the management of PPCM is to reduce preload and after load and increase the cardiac contractility. Heart failure during pregnancy may be acute or acute on chronic. The pregnant patient with known cardiac disease can present in stable condition during early stages of pregnancy. Careful physical examination should be done. Their management is mainly adjustment of their medication and monitoring for cardiac failure. The initial New York Heart Association functional class status should be documented. Serial ECG and echocardiogram should be performed.

Patients presenting heart failure during pregnancy or the peripartum period require a detail history and physical examination and the evaluation of severity of decompensation. An ECG may reveal deteriorating left ventricular functions, arrhythmia, LVH, or arterial abnormality. The therapeutic approach in these patients includes optimizing hemodynamics, reducing after load, optimizing preload, and cardiac contractility. These can be achieved by treatment of pulmonary congestion, control of hyper-/hypotension, treatment of cardiac arrhythmia, and prevention of thromboembolic events.
