My sister was diagnosed with peripartum cardiomyopathy during her pregnancy. Her age is 31 and weight is 55. She delivered a baby girl through normal delivery. 2D echo report says 20%-25% heart function (LVF). But she is not having any external symptoms like swelling, breathing problem, tiredness or high BP.
I have a few questions about her disease and treatment. Is this curable? How much time will it take to get completely out of it? How frequent should she visit a cardiologist and review 2D echo reports? Will fixing an ICD with surgery help her in handling sudden cardiac arrest? What is the approximate cost? If required, is heart transplant possible?
What precautions should be taken? When can an emergency situation arise? Should we keep some emergency medicines ready at home? Is there a chance for her baby girl to have a similar problem when she grows up? Please help.
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Before I answer your questions in detail, I would like to tell you that if she is totally symptom-free and her ejection fraction (EF) is 20-25%, please do get another echo done from an independent reliable source to confirm the diagnosis.
The condition peripartum cardiomyopathy or PPCMP has no definite cure. A proportion of patients will completely recover while some may have partial recovery and will continue to have low ejection fraction and symptoms. Some unfortunate patients see no improvement and may not survive for long. There is no definite period of recovery even for those who recover completely. Continuous improvement of up to five years has been seen.
The frequency of visit depends upon her problems and her cardiologist. Whenever she has a problem she should visit the cardiologist or whenever the cardiologist calls her, she must visit. The frequency of echo is decided by clinical circumstances and depends upon symptoms. I do first follow up echo after 6 weeks in my patients if there is no emergent symptom.
ICD or internal cardiac defibrillator is indicated in patients with low ejection fraction. It helps in the prevention of death caused by ventricular tachyarrhythmia. However, since low EF may revert towards normal in a subset of patients, one should wait for three to six months. In western countries, a wearable ICD (not surgically implanted) is sometimes used for these three to six months. Cost of ICD implantation is nearly four to five lakhs.
Yes, a heart transplant is possible and is available in major cardiac centers of metros. Do take your medicines on time. Do not over exert. Stick with recommended salt and water intake. Avoid alcohol. Avoid steroids and painkillers. Only take medicine under the supervision of your cardiologist.
None can tell that when an emergency situation will arise. Do take medicine as prescribed by your cardiologist. Visit health facility in case of an emergency. No emergency medicines can be prescribed as such. Although a number of case reports are available regarding the occurrence of PPCMP in daughters and sisters of patients of PPCMP. However, systematic studies regarding such an association are not available. In fact, routine genetic studies of PPCPM patients are not recommended as yet.
Thank you doctor,
Actually, the problem is she feels very normal. But she feels tired sometimes and gets stressed. Her cardiologist has not called her for the follow up so soon. What should be an ideal follow up interval if symptoms are not noticed or condition does not improve? Would you suggest an ICD implantation if the condition does not improve after three to six months? When is the right time to consider heart transplant as an option?
Welcome back to icliniq.com.
Since she requires standard therapy for heart failure she should be evaluated accordingly. I normally call my patients every fortnight till optimization of therapy.
If the ejection fraction less than 30%- 35% despite optimal medical therapy as per guidelines even after six to nine months, the patient may be considered for ICD implantation.
Heart transplant is indicated if patient refractory heart failure (stage D) despite optimal therapy or has circulatory shock requiring mechanical support. However, it does not seem to be a consideration in your case right now.
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