Peripartum cardiomyopathy: An intensivist's perspective

Peripartum cardiomyopathy (PPCMP) is a relatively rare form of dilated cardiomyopathy with unknown etiology. A generally accepted definition comprises the following criteria: 1) cardiac failure occurring in the last month of pregnancy or within 5 months after delivery; 2) absence of an alternative cause for the cardiomyopathy; 3) absence of heart disease before the last month of pregnancy and 4) demonstrated left ventricular dysfunction. From an intensivist's perspective, the diagnosis of PPCMP should always be considered when triaging a woman with peripartum respiratory or hemodynamic distress. Timely diagnosis is crucial to enable prompt initiation of the proper management in order to minimize the risk for serious maternal and neonatal sequelae. Goal-directed echocardiography should be utilized as early as possible, preferably already in the emergency department, to demonstrate or rule out PPCMP. Only then, appropriate supportive measures such as appropriate medical therapy, intra-aortic balloon counter pulsation (IABP), extracorporeal membrane oxygenation (ECMO) or assist device support can be initiated.