Peri-partum/post-partum cardiomyopathy is a dilated cardiomyopathy that may occur in the last trimester of pregnancy through the first several months post-partum.
The pathogenesis of post-partum cardiomyopathy is uncertain, with genetic factors, sympathetic tone, hormones, and malnutrition all suggested as contributing factors to its development.
- chest radiograph demonstrates cardiac silhouette enlargement
- appearance is indistinguishable from other forms of dilated cardiomyopathy and the diagnosis is suggested by the patient history
- findings of pulmonary oedema are dependent on the amount of systolic dysfunction
- can establish left ventricular systolic dysfunction
- cine SSFP sequences can demonstrate systolic dysfunction, similarly to echocardiography
- delayed enhancement in the left ventricular mid-myocardium has been described in the anterior and anterolateral wall 2
Treatment and prognosis
The prognosis is better than in other forms of dilated cardiomyopathy, but progressive deterioration of systolic function may occur. A heart transplant may become necessary.
Gadolinium contrast is contraindicated in pregnant patients and caution should be exercised in considering its use before delivery.
The necessary information for a presumptive diagnosis will often be possible without gadolinium contrast. Contrast may be useful for evaluation of therapeutic response postpartum, however.
- 1. Fuster V, Walsh R, Harrington R. Hurst's the heart. McGraw-Hill Professional. ISBN:0071636463. Read it at Google Books - Find it at Amazon
- 2. O'Donnell DH, Abbara S, Chaithiraphan V et-al. Cardiac MR imaging of nonischemic cardiomyopathies: imaging protocols and spectra of appearances. Radiology. 2012;262 (2): 403-22. Radiology (full text) - doi:10.1148/radiol.11100284 - Pubmed citation