Peripartum cardiomyopathy: a short review.

Peripartum cardiomyopathy is an unusual form of dilated cardiomyopathy, which manifests as acute heart failure in the last trimester of pregnancy or early postpartum period. Its aetiology is currently unknown. The presenting signs and symptoms are those of congestive heart failure and more specifically those of left ventricular failure. Its importance lies in the fact that it has a high mortality rate and strikes the patient in the prime of life. Peripartum cardiomyopathy has far reaching implications for the anaesthesiologist. The reason for this is that many of the signs and symptoms of normal pregnancy are indistinguishable from mild cardiac failure so that the condition may remain undiagnosed and can present suddenly at the time of induction of anaesthesia or in the peri-operative period. The goals of anaesthetic management include avoidance of drug induced myocardial depression and prevention of increases in ventricular preload and afterload. Vigilant monitoring is essential throughout the surgery and in the postoperative period and the need for invasive monitoring should be assessed according to the clinical condition of the patient. It is important to recognise the association of cardiac failure and pregnancy as a separate syndrome so that peripartum cardiomyopathy can also be kept as a differential diagnosis for cardiac failure occurring in the peripartum period and a high index of suspicion should be maintained for the timely detection and management of this condition.