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Peripartum Cardiomyopathy (Pathophysiology (Increase in red cell mass and…
Peripartum Cardiomyopathy
Pathophysiology
Increase in red cell mass and blood volume
Increase in Preload (ventricular elongation at the end of diastole)
Increase in HR and SV (15-20%)
Increase in Cardiac Output
Increased Hemodynamic Stress
Lengthening of tissues/ stretching of sarcomeres of the myocardium
Heart Becomes Enlarged including chambers
Muscle of the heart weakens
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Pro-Inflammatory State; increased levels of cytokines such as TNF-alpha and interleukin-6 activated by stress
Autoimmune Response; high level of antibodies causing changes in mothers immune system during pregnancy (immuno-suppression)
Potential Lifestyle Factors; Obesity, HTN, DM, History of Heart Disease, Malnutrition, Smoking, Alcoholism, Multiple Pregnancies
Genetic Factors; clusters of families with PPCM observed
Myocarditis
Toxic Hormonal Environment
Medical Management
Outpatient Milrinone Infusion
0.25 mcg/kg/min- vasodilator to decrease blood pressure and assist in optimal cardiac-loading conditions.
LVAD
Blood thinners, blood work regularly, diet/ fluid intake, care of driveline; care of exit site, BP medications
Lasix & Aldactone
Diuretic
Captopril
ACE inhibitor. Treats high blood pressure and heart failure.
Carvedilol
Treats high blood pressure and heart failure.
Assists with normalizing the force-length relationship of the myocardium
Medications