Peripartum Cardiomyopathy. Kyleah Bowder. Concordia University

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1 Peripartum Cardiomyopathy 1 Peripartum Cardiomyopathy Kyleah Bowder Concordia University

2 Peripartum Cardiomyopathy 2 Cardiomyopathy is the deterioration of the myocardium in the heart. The myocardium is the middle of the three pericardial layer it is also known as the muscular tissue of the heart. This is an extremely thick layer of cardiac muscle. Concerning its histology the myocardium is striated and obtains the presence of intercalated discs and gap junctions. The word cardiomyopathy broken down means heart muscle disease, because of it s name cardiomyopathy could potentially be used to describe any number of different diseases that affect the heart. In the professional scene it is generally reserved only to describe such diseases that are described as severe disease of myocardial muscle leading to heart failure. Peripartum Cardiomyopathy is a rare form of the disease that occurs usually between the last month of pregnancy and five month prior to giving birth, it is often referred to as postpartum cardiomyopathy. The onset of this disease is rare and generally the women that it effects have no prior underlying heart disease and no reason to have developed the disease. Peripartum Cardiomyopathy is a form of dilated cardiomyopathy meaning it is a condition in which the heart becomes weakened and enlarged and it in turn cannot pump blood efficiently. This decreased heart function plays into the functioning roles of the lungs, liver and other body systems. Although dilated cardiomyopathy is the most common type of cardiomyopathy, peripartum is quite rare. The development of this disease is happening world wide but it s occurrence is higher in developing nations. ( p.1) It is has been found that with peripartum cardiomyopathy there is an involvement of systolic dysfunction of the heart which leads to a decrease in the left ventricular ejection fraction. This means that there is a decrease in the amount of blood being pumped out of the left ventricle with each contraction, showing that the heart is weak. This disease is characterized by the possibility for very quick recovery that is sometimes outweighed by the chance of heart failure and death.

3 Peripartum Cardiomyopathy 3 The cause for the development of peripartum cardiomyopathy(ppcm) is unknown but there have been many different suggestions with data to follow. PPCM has been happening around the world but according to recent studies it is much more common in countries of lesser development. In Haiti it has been found to occur one case for every 299 live births compared to the United State one case for every 4,000 live births. It is thought that there is a mix of factors contributing to the development of PPCM, such as genetic disposition, differences in cultural practices, environmental factors and standards of prenatal care but none of them have ever been fully proven. In regards to development in countries like Haiti, there we early assumptions that nutritional factors might exist. There have been other links to peripartum cardiomyopathy as well. It was found that physiological changes during pregnancy too had an effect on the diseases onset. These changes generally boost maternal antioxidant defense mechanisms but it was found that in PPCM patients there were high levels of oxidative stress present. This stress lead to the to the enhancement of the anti-angiogenic properties of the hormone prolactin that are instrumental in the process of destroying cardiac and vascular tissues. Along with this oxidative stress patients with PPCM have commonly had myocardial inflammation. The cause of this inflammation still remains unknown but there are varying lines of evidence for and against this inflammation contributing to the development of peripartum cardiomyopathy. In select grouping of different patients there were some groups with very high rates of this inflammation being present, but on the contrary, universally, the rates are not very high. In addition to these scarcely reliable known causes, the biophsychosocial model may shed some light on the development of this disease in relation to the factors that increase the chances for heart disease in general. As stated before, when PPCM occurs, it is clear there is no

4 Peripartum Cardiomyopathy 4 underlying heart problems or factors that would contribute to the development of a heart disease. Day to day life including nutrition, exercise, and emotional states can still have an affect on any state of the body, including patients with PPCM. Biological factors regarding PPCM have been explored and there have been some correlations but nothing concrete enough to state as a cause. The way a person is made up genetically leaves room for anything to happen. There have been mutations associated with familial dilated cardiomyopathy genes in patients with PPCM suggesting that there may be an overlap in the clinical spectrum of these two diseases ( pg. 2). Having a predisposition to dilated cardiomyopathy, such as an immediate family member with the disease can possibly be linked to the probability that someone could develop PPCM themselves. Other tests comparing and contrasting different mutations have been done and if they represent a true association between cardiac gene mutations and PPCM they may pave the way for the future, to be able to conduct genetic screening tests for peripartum cardiomyopathy. This screening could have an enormous impact on the mortality rate of women with PPCM because when treated correctly and effectively, the recovery probability is typically high. The psychological factors present in any person at anytime has a direct affect on the person s immune system and overall quality of life. It has been seen that stress can decrease immune function significantly. There have been many presumptions that immune function during pregnancy and prior to pregnancy can influence the development of PPCM. If this were to be true, women with high stress levels during or before pregnancy may lead to decreased immune function and more susceptibility to peripartum cardiomyopathy. This is why it is so important not only for pregnant women, but people in general to take care of themselves because

5 Peripartum Cardiomyopathy 5 cognition, emotion, and motivation in life can all lead to changes in the body physical for the worse or for the better. Socially the existence of peripartum cardiomyopathy has a dominant presence. Where people live and how they live their life also affect their bodies. In lesser developed countries things are much different from that of a well developed country. As stated before there are much higher rates of PPCM occurring in these lesser developed areas as opposed to places like the United States. There can be a variety of reasons for this. One of the most dominant being cultural differences. Medical practices and prenatal care are likely different from one another. The way people interact with people are different and the way people eat and nourish themselves are different. Nutrition in early stages of research was seen as a direct link, which it is in many other diseases as well. Prenatal care is also not as efficient due to lack of funds and lack of knowledge, but also because of traditions and cultural practices. Treatment methods and medications for peripartum cardiomyopathy is similar to that of other forms of heart failure. The treatments specifically aim to reduce the after load and preload of contractility. If PPCM occurs before the baby is born, the angle of treatment may change due to the potential toxic effects on the fetus in using different medications.

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