Cardiomyopathy during pregnancy and after delivery

When you are pregnant, your body will experience many changes that lead to health problems. One of the conditions that can occur in pregnant women is heart problems, known as peripartum or postpartum cardiomyopathy. So, what is cardiomyopathy in pregnant women and after childbirth? How to handle it?

What is cardiomyopathy during pregnancy and after childbirth?

Cardiomyopathy is a disease related to the heart muscle. In this condition, the heart muscle weakens so that it cannot work optimally in pumping blood throughout the body.

Cardiomyopathy can happen to anyone, including pregnant women. In pregnant women and after childbirth, a weak heart is also known as peripartum or postpartum cardiomyopathy. Generally, this type of cardiomyopathy attacks pregnant women at the end of pregnancy or five months after giving birth.

Peripartum cardiomyopathy is generally the same as the type of dilated cardiomyopathy (dilated chardiomyopathy), which is a condition when the left ventricular chamber of the heart enlarges and the muscle walls become stretched and thin. This condition causes the heart to weaken so that its ability to pump blood is reduced.

If you are unable to pump blood, less blood is removed from the left ventricle of the heart. In the end, the heart cannot meet the nutritional and oxygen needs of other organs, which are carried through the blood.

This condition can also cause a buildup of blood or fluid in other body tissues, including the lungs, causing various symptoms, such as shortness of breath. If left untreated, cardiomyopathy during pregnancy can cause dangerous complications, including irregular heartbeats (arrhythmias), heart valve abnormalities, and heart failure.

What are the causes and risk factors for peripartum and postpartum cardiomyopathy?

Peripartum cardiomyopathy is a rare disease. Cardiomyopathy UK says, this condition affects about one in 5,000 to one in 10,000 women or one in 2,000 women.

Heart disease that occurs during pregnancy does not have a definite cause. However, experts believe, the occurrence of peripartum and postpartum cardiomyopathy is associated with heavier heart muscle performance during pregnancy.

The reason is, during pregnancy, the heart muscle pumps up to 50 percent more blood than when it is not pregnant. This is because the body is subject to additional burdens, namely the fetus, which must get a supply of essential oxygen and nutrients.

Apart from this, genetic factors (heredity) can also be one of the causes of cardiomyopathy in pregnant women and after childbirth. The reason is, cardiomyopathy is a heart disease that can be inherited, including during pregnancy.

Although rare and have no definite cause, there are several other factors that can increase a person's risk of developing heart problems during pregnancy. Here are some of these factors:

• Excess weight (obesity).
• There is a history of high blood pressure or hypertension, including preeclampsia.
• Diabetes.
• History of heart disease, such as myocarditis (inflammation of the heart muscle) or coronary artery disease.
• Viral infection of the heart.
• Malnutrition.
• Smoking habit.
• alcohol consumption.
• Are over 30 years of age.
• Use of certain drugs.
• Multiple pregnancy.
• Have been pregnant before.

What are the symptoms of cardiomyopathy during pregnancy and after delivery?

The symptoms of cardiomyopathy that occur in pregnant women and after childbirth are generally similar to those of heart failure. Some of the symptoms that may occur include:

• Heart palpitations (palpitations) or abnormally fast heartbeats.
• Shortness of breath, especially when resting or lying on your back.
• Low blood pressure or blood pressure decreases when standing.
• Cough.
• Chest pain.
• Great fatigue.
• Tires easily during physical activity.
• Swelling of the feet and ankles.
• Frequent urination at night.
• Swollen veins in the neck.

The symptoms of peripartum or postpartum cardiomyopathy above are generally similar to those commonly felt in pregnancy, especially the final trimester. However, you need to be aware if the symptoms you feel get worse and last a long time.

If this happens to you, you should immediately consult a doctor to find out the diagnosis and get the right treatment.

How is cardiomyopathy diagnosed during pregnancy and after delivery?

When you experience the symptoms listed above, you may be referred to a cardiologist for a proper diagnosis. In determining the diagnosis, the doctor may perform several physical examinations, including finding out your medical history and since when you started experiencing it.

Some physical examinations that may be done include looking for signs of fluid buildup in the lungs, using a stethoscope to determine the condition of the heartbeat, and checking blood pressure.

After performing a physical exam, your doctor may also ask you to do some tests. These tests will need to be done to check how well your heart is working and whether the symptoms you are experiencing are just normal pregnancy symptoms or are related to cardiomyopathy.

Here are some tests you may need to undergo to diagnose peripartum or postpartum cardiomyopathy, in pregnant women and after delivery:

• Chest X-ray, to find out if there is fluid in the lungs.
• CT scan, for the whole picture of the heart.
• Echocardiography, to see the structure and function of muscles and heart valves. Then also check whether there are clots in the chambers of the heart.
• Electrocardiography (EKG), to see how electrical impulses are carried out in the heart and check for abnormal heart rhythms (arrhythmias).
• Blood tests, to check how your kidneys, liver, and thyroid are working, to look for other causes of your heart problem.
• Urine test, to find out if there are signs of preeclampsia or urine infection in you.
• Coronary angiography, to see the flow of blood in your coronary arteries.
• Cardiac MRI, to look at the structure and function of your heart. Generally this is done if your echocardiography results don't show any clear signs.

After performing the various tests above, you can be said to have peripartum / postpartum cardiomyopathy if the symptoms appear in the last months of pregnancy or within 5 months after delivery, along with an enlarged heart, very visible symptoms of heart failure, the pumping function of the heart. reduced by an ejection fraction of less than 45%, and no other cause of your symptoms.

What are the treatment options for cardiomyopathy during pregnancy and after delivery?

Women who have peripartum and postpartum cardiomyopathy generally need to be hospitalized until the symptoms can be controlled. Your doctor will recommend treatment based on the severity of your condition.

The American Heart Association (AHA) said, the goal of peripartum cardiomyopathy treatment is to prevent fluid buildup in the lungs and help the heart recover as much as possible. You may also need to relax your blood vessels to lower blood pressure, which reduces strain on your heart.

To achieve this goal, most women only need drugs. If you are receiving drugs, you should always consult with your doctor about the right medicine for your condition.

Take drugs

To treat cardiomyopathy during pregnancy and after childbirth, most women only need medication. If you are receiving drugs, you should always consult with your doctor about the right medicine for your condition.

Here are some medications that doctors may prescribe to treat cardiomyopathy in pregnant women and after childbirth:

• ACE inhibitors

This medicine is usually given after delivery, to calm the heart muscle around the blood vessels so that the heart's workload is reduced and it can pump blood easily. However, mothers who take this type of medicine are generally no longer able to breastfeed their babies.

• Beta-blockers

These drugs work by blocking the hormone adrenaline, which increases the heart rate, so that the heart rate becomes more stable and the force of the heart's contractions is reduced.

• Diuretic

Medicines that reduce fluid buildup in the lungs or ankles by encouraging urine production.

• Digitalis

Medicines that strengthen the heart's ability to pump blood.

• Anticoagulants

Medicines of this class help thin the blood so that blood clots do not occur. The reason is, cardiomyopathy, including in pregnant women, is prone to causing blood clots.

Apart from medication, in rare cases, women who are pregnant or who have had cardiomyopathy after childbirth may require other treatment, such as a heart pumping device or even a heart transplant. However, this generally occurs when the cardiomyopathy has progressed to severe heart failure.

Lifestyle changes

Apart from medical treatment, those of you who experience cardiomyopathy during pregnancy and after childbirth may also need to follow a low salt diet and maintain an ideal body weight to prevent your heart problems from getting worse. You may also be recommended by your doctor to drink only 1.5-2 liters of water per day to reduce pressure on your heart.

Also, you need to avoid alcohol and cigarettes, as these can make your symptoms worse. You also need to get enough rest and manage stress well.

How does peripartum cardiomyopathy affect pregnancy and childbirth?

The effect of peripartum cardiomyopathy on pregnancy and infant development depends on when the condition started and how severe the symptoms are. The sooner the diagnosis is made, the sooner treatment is carried out, so that it can be more effective at preventing more severe conditions. Therefore, it is important for pregnant women and those after giving birth to detect these symptoms.

In pregnant women who experience cardiomyopathy, generally the baby will be delivered by caesarean section. However, normal delivery may be carried out in accordance with the conditions of each pregnant woman.

Therefore, you need to routinely go to your obstetrician during pregnancy for antenatal examinations and always consult your doctor about proper delivery.

How to prevent cardiomyopathy in future pregnancies?

Women who have had peripartum and postpartum cardiomyopathy generally recover and their heart function returns to normal within six months of delivery. However, some women may also take up to years to recover because their condition is more severe.

In addition, previously experienced cardiomyopathy may recur in subsequent pregnancies, with a recurrence rate of around 30 percent. In fact, the symptoms you feel may be more severe.

Therefore, if you are planning your next pregnancy, you should consult your cardiologist to ask about the potential risks that may arise.

You also need to maintain a healthy heart by adopting a healthy lifestyle, including eating a healthy and balanced diet, avoiding smoking and alcohol, and exercising regularly. Talk to your doctor about the right exercise for you and how regularly you need to do it.

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