Anesthetic Management Of Peripartum Cardiomyopathy

Peripartum cardiomyopathy (PPCM) is an infrequent but critical disorder. It is classified as a specific cardiomyopathy with the development of heart failure in the last month of pregnancy or within five months after delivery.Incidence of PPCM ranges from approximately 1:15,000 pregnancies in the United States to as frequent as 1:299 pregnancies in Haiti.The actual etiology of Peripartum cardiomyopathy is unknown.Major risk factors include multiparity, advanced age, multiple gestation, pre-eclampsia and gestation high blood pressureIn general, treatment of peripartum cardiomyopathy is similar to that of other forms of coongestive heart failure.Peripartum cardiomyopathy can lead up to heart failure, oedema, embolic events, chest pain, cardiomegaly and exercise related dyspnea. Because of the high risk of mortality (30-60%), the cardiologist may not allow the patient to have normal vaginal delivery.Anesthetic managment techniques are variable. General anesthesia carries the advantage of securing the air way and the possibility of performing transoesophageal echo if needed. However inhalational anesthetics may cause myocardial depression from mild to severe forms. Intravenous agents can pass the fetoplacental barrier causing fetal depression. Regional anesthesia can be used safely except for those with severe cardiovascular compromise and the timing of thromboprophylaxis may prevent its use. Slow induction of epidural anesthesia guided by pulmonary artery pressure measurement has been reported.