Synopsis
Distinguish pathological peripartum heart failure from normal pregnancy symptoms and coordinate pregnancy-safe acute, chronic and future-pregnancy care.
- PPCM is otherwise-unexplained heart failure from LV systolic dysfunction, usually LVEF below 45%, towards the end of pregnancy or in the months after birth.
- Orthopnoea, PND, resting tachycardia, raised JVP, hypoxia and pulmonary oedema are not normal pregnancy discomforts.
- TTE confirms ventricular dysfunction and identifies RV involvement, valve regurgitation and intracardiac thrombus.
Key red flags
Pulmonary oedema, hypoperfusion, malignant arrhythmia, embolic neurology or severe biventricular failure requires critical care and Pregnancy Heart Team activation.
Investigation priorities
Detect arrhythmia, conduction disease and ACS clues.
Management branches
Peripartum HF symptoms with objective abnormality.
- Assess ABCDE, oxygen only for hypoxaemia, ECG/monitoring, IV access, labs including NT-proBNP/troponin and urgent echo; involve obstetrics and cardiology immediately.
- Treat pulmonary congestion with cautious loop diuretic and position/ventilatory support; manage unstable arrhythmia by standard emergency principles with fetal considerations.
Haemodynamically stable postpartum PPCM.
Key medicines
FurosemideCommon oral starting dose 20-40 mg once daily; in acute pulmonary oedema use an individualised IV dose based on severity and prior exposure.
Enalapril (postpartum only)After delivery, start 2.5 mg orally once daily for symptomatic heart failure under close BP supervision; titrate over 2-4 weeks toward the usual maintenance 20 mg/day in one or two doses, to a maximum 40 mg/day in two divided doses, as tolerated.