hidden

Peripartum Cardiomyopathy: Go Red & Recognize!

This one is dedicated to all women and their families who have been affected by Peripartum Cardiomyopathy (PPCM). Seldom detected, systolic heart failure can come as a surprise especially in young women. Developing heart failure during pregnancy, in the post-partum period or any other time throughout a subsequent pregnancy is not something any woman wants to worry about specially around the birth of their child.

The 2010 Heart Failure Association of the European Society of Cardiology Working Group defines PPCM to “an idiopathic cardiomyopathy presenting with Heart Failure (HF) secondary to Left Ventricular (LV) systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause of heart failure is found”1, hence a diagnosis of exclusion.

The annual incidence of PPCM continues to increase. Women present with wide range of HF symptoms. Although some have complete recovery with guideline directed medical treatment, others have persistent myocardial dysfunction, advance heart failure and death which subsequently leads to devastating consequences for an entire family.  Delays in diagnosis usually occur because the symptoms and signs of PPCM can mimic the normal findings of pregnancy.  Early recognition and treatment of PPCM could lead to improvements in maternal and fetal mortality and morbidity. Easier said than done.

By the time a patient with PPCM sees a cardiovascular specialist, they often have worsening symptoms of heart failure with moderate to severe depressed left ventricular systolic function which means it was later recognized by either a primary care physician and/or an obstetrician-gynecologist prior to referral.

Awareness is key in early detection of PPCM. If you see something, say something. Think PPCM in all pregnant women. Since we mentioned that survival and recovery are both improved by early diagnosis, there is a validated self-test that can help with discerning heart failure from pregnancy related symptoms from Fett et al2. (Table 1.)

 

  1. Self-Test for Early Diagnosis of Peripartum Cardiomyopathy
Symptoms 0 points 1 point 2 points
Orthopnea None Need to elevate head Need to elevated 45 degrees or more
Dyspnea None Climb 8 or more steps Walking on level
Unexplained cough None At night Day and night
Excessive weight gain during last month of pregnancy None 2-4 pounds per week Over 4 pounds per week
Lower extremity edema None Below the knee Above the knee
Palpitations None When Laying down at night Day and night or any position

  The present of 4 or more points should prompt additional investigation.

 

Fett’s self-test can be an essential tool for the PCP and OB-GYN to aid in early detection of PPCM. Think about PPCM and use the self-test on all patients at risk to help guide further next steps in the diagnosis and management. In support of awareness of heart disease in women, think PPCM in which case the battle is half way won.

 

References:

  1.  Sliwa K, Hilfiker-Kleiner D, Petrie MC, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail 2010;12: 767–78.
  2. Fett, JD .Validation of a self-test for early diagnosis of heart failure in peripartum cardiomyopathy. Crit. Pathw. Cardiol. 10(1), 44–45 (2011).

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

hidden

The American Heart and Go Red for Women Month!

It is February: The American Heart and Go Red for Women Month!

February has just started with all its excitement and optimistic thoughts!! I would like to talk about some of the amazing initiatives, including American Heart Month and Go Red for Women initiatives, that are in place to inspire and encourage more of my colleagues, women and men equally, to step up and be proactive about women’s health and education!

  • When was the first American Heart Month?

It was in February 1964, proclaimed by President Lyndon B. Johnson, and Congress subsequently requested the President to issue a proclamation designating February as American Heart Month annually.

  • What is the Go Red for Women Initiative?

It is an initiative, launched in 2004, to end heart disease and stroke in women; by increasing awareness of these diseases in women and removing barriers women face to achieve a healthy life. Here is what GO RED means:

  • G: GET YOUR NUMBERS

Ask your doctor to check your blood pressure and cholesterol.

  • O: OWN YOUR LIFESTYLE

Stop smoking, lose weight, exercise, and eat healthy.

  • R: REALIZE YOUR RISK

Know your risk; heart disease is responsible for 1 in every 5 female deaths [1].

  • E: EDUCATE YOUR FAMILY

Make healthy food choices for you and your family.

  • D: DON’T BE SILENT

Tell every woman you know that heart disease is our No. 1 killer [1].

  • How about “Research Goes Red” initiative?

It is an initiative to increase women’s participation in scientific research. Both healthy women and those with acute or chronic diseases are encouraged to participate.

  • What impact have these initiatives achieved?

The impact of these initiatives has been remarkable and quite impressive!! Here are some of their achievements:

  • More than 25,000 women registered for the Research Goes Red initiative!
  • Around 19 million women interact with Go Red through digital platforms annually.
  • $600 million raised to support research, education, advocacy, prevention and awareness programs.

Seeing the impact of these initiatives, I am hopeful not only that these initiatives continue to include and support more women, but also I am optimistic that more initiatives are launched to: (1) increase awareness of different heart diseases in women, (2) empower women to know the differences in the clinical presentations of different diseases, (3) implement strategies to avoid health care disparities based on gender and race, and (4) help more women and minorities access health care, not only across the nation but also across the globe.

 

Reference

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”