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When Mama’s Heart is too big: Peripartum Cardiomyopathy

January 14th, 2011

Mamas on Bedrest, despite all the love in your heart for your babies, your heart can actually become too big!

Such was the case for Brenda Torigiani (Pictured left at 36 weeks,  just before her delivering her daughter, Right before pregnancy). This 22 year old first time mama was eagerly awaiting the birth of her daughter and looking forward to subsequent pregnancies. But when she experienced marked swelling, elevated blood pressure and  severe shortness of breath  her condition became life threatening. Her daughter was delivered via cesarean section at 36 weeks when she was diagnosed with congestive heart failure and an enlarged heart.  Brenda had peripartum cardiomyopathy. Your can hear Brenda’s story here.

Peripartum Cardiomyopathy occurs when a mama’s heart dilates (enlarges) during pregnancy and the heart muscle loses its elasticity resulting in congestive heart failure. The large, sluggish heart is unable to accommodate the additional fluid volume created by pregnancy. It does not pump as efficiently; blood and fluids pool in the body tissues causing marked swelling(Below, Brenda Torigiani’s feet at 7 mos). Oxygen delivery to cells is decreased and fluid is often trapped in the lungs causing difficult,

rapid breathing. Other symptoms include high blood pressure, increased heart rate, cough and inability to urinate (urine output is often decreased, scant or not at all). Clinically, patients have have an enlarged heart on echocardiogram, an abnormal EKG, heart murmur, venous distention, and an ejection fraction (amount of blood the heart pumps) less that 50%. Heart valves typically are not closing properly and may be damaged, allowing for back flow of blood into heart chambers and the lungs.

Peripartum Cardiomyopathy typically presents in the final weeks of pregnancy. A rare condition, it affects only 1 out of every 3000 to 4000 pregnant women. However, if not diagnosed and treated, patients can acutely experience “florid heart failure” essentially drowning in their own body fluids. These women are at increased risk of thromboembolism (blood clots that can migrate to the heart, lungs or brain), stroke and sudden cardiac death. Many women require heart transplants. Others are managed medically with drugs.

The exact cause of peripartum cardiomyopathy is unknown. Some theorize that it is a result of a viral or inflammatory process causing a myositis (inflammation of the heart muscle). Others theorize that it is an autoimmune process. Unfortuantely (or fortunately) so few women experience peripartum cardiomyopathy that good, controlled studies have not been possible.

For now, peripartum cardiomyopathy is treated like any other idiopathic cardiomyopathy (enlarged hearts that have no identifiable origin). The first step is to stabilize the patients and this is done by diuresing (drawing off) the excess fluid and relieving the strain on the heart. Patients are given aggressive diuretics and  medications to help the heart pump more effectively, to keep the fluid volumes traveling through the heart low and to reduce blood pressure and heart rate. They are placed on water and salt restrictions as well to control swelling as moderate exercise such as walking and cycling to increase cardiac function. (A goal is to keep the ejection fraction -the heart’s pumping index- above 55%).  Many patients will suffer irreversible heart damage and be at increased risk of sudden cardiac death. For these women, an implantable cardiac defibrillator may be necessary. These women are also at increased risk of thromboembolism and will need anticoagulant (blood thinning) medications. Some women will respond well to therapy and the cardiomyopathy will resolve within 6 weeks to 6 months post partum. For those that do not,  a heart transplant may be necessary. Women who do not have marked improvement in symptoms within the first few weeks post partum have a poorer prognosis as do African American women, women who have had several children and women older than 30 years old. Sadly, for many women the complications are fatal-not only for themselves but also for their babies.

Most women who have peripartum cardiomyopathy are advised not to have any more children. However, some women go on to have additional pregnancies. The outcomes are variable.

As for Brenda, she would like to have more children, but currently her OB and cardiologist have advised against this for the immediate future. She hopes that she’ll be able to have one more biologic child. She and her husband have already planned to adopt. (pictured here with infant daughter Chyanne)

Peripartum Cardiomyopathy is a rare but life threatening medical condition that affects women of childbearing age. It’s origin is still unknown but it can be managed. If you are pregnant and experience:

  • Rapid weight gain
  • Marked Swelling
  • Difficulty breathing
  • Chest heaviness
  • Cough
  • Rapid heart beat
  • High Blood Pressure
  • Disorientation
  • Fatigue

Be evaluated by our doctor immediately. You may be developing or have heart failure. Treatment needs to be initiated immediately to avoid any progression in heart failure, to minimize damage to the heart muscle and to save your life and the life of your baby.

Thanks to Brenda Torigiani for sharing her story and the photos chronicling her ordeal.

References

A. Nabhan, MD “Peripartum Cardiomyopathy” ASJOG vol 2 March 2005. pgs 231-237

D. McNamara, MD “Treatment of Peripartum Cardiomyopathy” Heart Failure section, Cardiovascular Institute of the University of Pittsburgh Medical Center, Pittsburgh, PA 2001.

M. Carson, MD “Peripartum Cardiomyopathy” MedScape Article, September 8, 2010

Resources

A Mother’s Heart– A peripartum cardiomyopathy support network.

Peripartum Cardiomyopathy Survivors! Facebook page

Peripartum Cardiomyopathy: Brenda Torigiani’s Story

January 14th, 2011

First time mama Brenda Torigiani experienced profound shortness of breath, heart palpitations and edema in the latter weeks of her pregnancy. What was initially attributed to “new mommy nerves” was later found to be congestive heart failure due to an enlarged heart . Here’s her story in her own words as Brenda seeks to raise awareness about this potentially deadly disorder.