By Joanne K. Mazzarelli, MD
Despite improvements in detection and treatment, heart disease remains the number one cause of death for women in the United States. In recent years, more focus has been placed on the differences between men and women in regard to cardiovascular disease. Ninety percent of women have one or more risk factors for heart disease. Many patients are surprised to find that some risk factors for heart disease happen early in a woman’s life, often in the child-bearing years.
A small proportion of pregnant and post-partum women can develop a cardiomyopathy, a weakening of the heart muscle. This condition can happen during the last month of pregnancy, in which case it is termed peri partum cardiomyopathy. If it occurs up to five months following childbirth, it is called post-partum cardiomyopathy. Both are abbreviated PPCM. While the cause is not exactly known, it is speculated that several factors play role, including inflammation of the heart muscle, poor nutrition, small vessel disease, and genetics.
PPCM occurs when the heart muscle weakens and is unable to contract as strongly as it should. The heart chamber may also enlarge. When the heart muscle is weak and unable to pump blood out as effectively as normal, a patient can develop signs and symptoms of congestive heart failure. This can become a very serious condition for both the mother and baby.
While PPCM is relatively rare, it can be very serious. It also can be difficult to detect, as symptoms are often the same as a normal third-trimester pregnancy. However, the typical swollen feet, fatigue, and trouble breathing associated with the third trimester will usually resolve after the baby is born. When a woman develops PPCM, symptoms are more pronounced and persist well after the baby is born. Some of these symptoms include:
- Swelling in the feet, legs, and abdomen.
- Shortness of breath and markedly decreased ability to exert oneself.
- Decreased exercise tolerance.
- Inability to lie flat at night because breathing is too difficult.
It is very important that women get regular check-ups during pregnancies and report any symptoms, especially during the late stages of pregnancy. During an exam, the doctor will look for signs consistent with congestive heart failure that can occur with PPCM. Additional testing is necessary, such as bloodwork and an echocardiogram (ultrasound of the heart), along with referral to a cardiologist for further management. Medications are typically recommended to treat symptoms and improve heart function. Recovery is possible, but patients need to be monitored closely.
Pregnant women are advised to observe a healthy diet, maintain a healthy weight, avoid alcohol and tobacco, and see their doctor regularly to decrease the chances of developing cardiac complications such as PPCM. If a woman is older or has chronic medical problems like diabetes, obesity, or high blood pressure going into the pregnancy, she may need to be seen by the doctor more frequently during the pregnancy.
It is important for women to be aware of the signs of heart disease at all stages of life, including the childbearing years. While still uncommon, cardiomyopathy during pregnancy can pose serious risks during pregnancy and after delivery.
To make an appointment with one of our female cardiologists, please call 1.800.8.COOPER