الفهرس 
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Abstract
One of the most severe heart diseases related to pregnancy is peripartum cardiomyopathy (PPCM). Peripartum cardiomyopathy (PPCM) is an uncommon, idiopathic complication of pregnancy associated with 10–30% mortality.
The European Society of Cardiology Working group on PPCM defines the disease as heart failure (HF) symptoms secondary to new left ventricular (LV) systolic dysfunction developing during the last months of pregnancy or within the immediate postpartum period. It occurs in the absence of an identifiable cause for HF with reduced ejection fraction (HFrEF) and represents a diagnosis of exclusion.
There are several risk factors and conditions associated with development of PPCM including; age, race, preeclampsia and multiple gestations. Other associated conditions have been reported but less well substantiated, including substance abuse, anemia, asthma, prolonged tocolysis, diabetes mellitus, obesity, and malnutrition.
There are many hypothesis including myocarditis, genetic succeptibility, fetal microchimerism, and autoimmune response, A ‘two- hit’ model of angiogenic imbalance in the heart during the peripartal period has recently been proposed, combining systemic antiangiogenic signals during late pregnancy and host susceptibility through insufficient local proangiogenic defences in the heart.
Pregnancy is a physiological state accompanied by maternal hemodynamic changes, during which time, signs and symptoms could mimic signs of heart failure. Awareness of these changes is of great importance for early recognition and timely management of PPCM, which correlate with better prognosis of these patients. Symptoms of PPCM, such as dyspnea, cough, fatigue, leg edema, malaise, are very often misinterpreted as physiological symptoms due to pregnancy. This is the reason of delayed recognition of PPCM, so at the moment of diagnosis patients are presented with NYHA III or IV functional class.
Transthoracic echocardiography is the most important tool for diagnostic confirmation or exclusion of PPCM and should be performed in every suspected case. Echocardiography enables prompt diagnosis and the evaluation of heart function. Thus, in any case of doubt or suspicion of heart failure, bed-side echocardiography should be done as soon as possible. PPCM is presented with systolic dysfunction, reduced cardiac output, and increased filling pressures, while left ventricular dilatation must not be always present. Echocardiographic diagnostic criteria for PPCM include: EF <45%, LVFS <30% or both, and LVEDD >2.7 cm/m2 body surface area. Valvular regurgitation can be present. In patients with EF ≤35%, left ventricular thrombus is often detected.