Is my swelling and shortness of breath normal during and after pregnancy?

Written by John Steuter, MD

What is peripartum cardiomyopathy?

Peripartum cardiomyopathy is a weakness of the heart muscle that begins during the final month of pregnancy through about five months after delivery, without any other known cause. Most commonly, it occurs right after delivery.

While it’s relatively rare peripartum cardiomyopathy can be life-threatening. Rates of prevalence vary widely from one in 3,000 births to one in 10,000 births.

What causes peripartum cardiomyopathy?

Peripartum cardiomyopathy is generally considered a form of idiopathic primary myocardial disease associated with pregnancy. Although several plausible etiologic mechanisms have been suggested, none of them are definite.

How can peripartum cardiomyopathy be treated?

The objective of peripartum cardiomyopathy treatment is to keep extra fluid from collecting in the lungs and to help the heart recover as fully as possible. Many women recover normal heart function or stabilize on medicines. Some progress to severe heart failure requiring mechanical support or heart transplantation. Medications for treating peripartum heart failure include standard heart failure medications if the patient has delivered. If still pregnant some standard heart failure medications are not recommended due to possible dangerous fetal effects. 

History of peripartum cardiomyopathy

Mild Cases
In a mild case of peripartum cardiomyopathy, typical symptoms such as swelling in the feet and legs, and some shortness of breath can be similar to the symptoms of the third trimester of a normal pregnancy, so these symptoms may go undiagnosed. The patient may then go on to recover without further medical attention.

Severe Cases
Severe cardiomyopathy can reveal itself if a patient becomes very short of breath and has swollen feet well after delivery. When the heart doesn’t pump well, fluid can accumulate in the body, most noticeably in the lungs and the feet. An echocardiogram can detect the cardiomyopathy by showing the diminished functioning of the heart.

Recovery
The degree of severity does not seem to affect the degree or rate of recovery. For example, patients with a very low ejection fraction can eventually completely recover from peripartum cardiomyopathy.  Some patients recover only part of their heart function over a period of six months or longer. With others, the heart returns to full strength in as little as two weeks.

Estimations of recovery vary but in general 30 percent of patients return to baseline ventricular function within six months, and 50 percent of patients have significant improvement in symptoms and ventricular function.

Future pregnancy

In women with persistent ventricular dysfunction, future pregnancy is not recommended, because of concern about the ability of the dysfunctional heart to handle the increased cardiovascular workload.  In those that have completely recovered, recurrence rates with a future pregnancy are higher than the general population and serious counseling with providers should take place to explain the risks.

For more information about peripartum cardiomyopathy or to refer a patient contact Bryan Heart. Call 402-483-3333.