How to get cured of peripartum cardiomyopathy?

Hi,

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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 to 25%, please do get another echo (echocardiogram) 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 six 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.

Hi,

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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 is less than 30 % to 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.