The Relationship Between Peripartum Cardiomyopathy and Preeclampsia – Pathogenesis, Diagnosis and Management

Figures & data

Table 1 Selected Drugs Used in PPCM Prepared on the Basis of Hilfiker-Kleiner et al. ⁸¹

Group of Drugs	Substance Name	Comment
ACEI	Captopril Enalapril Ramipril	Contraindicated in pregnancy (risk of kidney damage, malformations and hypotension in the fetus) No data on risk during pregnancy
Sartans	Candesartan Valsartan	Contraindicated during pregnancy and lactation
Potassium-sparing drugs	Spironolactone Eplerenone	Contraindicated during pregnancy and lactation (possible antiandrogenic effect on the fetus) Adverse effects not fully understood (FDA Category B)
Beta-blockers	Metoprolol extended-release Carvedilol Atenolol	Rare risk of bradycardia and respiratory failure in the newborn. Cardioselective agents preferred during pregnancy Risk of low birth weight and fetal bradycardia when administered in the second or third trimester
Vasodilators	Hydralazine Nitroglycerin	In combination with nitrates as a safe alternative to ACEI/sartans during pregnancy Risk of hypotension
Diuretics	Hydrochlorothiazide Furosemide	Risk of decreased placental blood flow. Use only if there are signs of stasis in the pulmonary circulation Use only if evidence of pulmonary stasis
Inotropic drugs	Digoxin Dobutamine Milrinone	To be considered at low EF. Caution for poisoning when used in high doses Not enough evidence for safe use during pregnancy
Anticoagulants	Warfarin Low-molecular-weight heparin	Risk of abnormal development of bones of the nose, limbs, articular cartilage, and risk of abnormalities of the visual, auditory, and central nervous systems Use if treated with bromocriptine. Include in women with EF < 35%.
Prolactin inhibitor	Bromocriptine	Increases thromboembolic risk; class of recommendation IIa, data reliability level C Medication schedule: 2.5 mg 2 ×/d for 2 weeks, then 2.5 mg once/d for another 6 weeks.
Heart rate reducing drugs	Ivabradine	Use in case of high heart rate. Contraindicated during pregnancy and lactation
Angiotensin receptor neprilysin inhibitors (ARNI)	Sacubitril/valsartan	Contraindicated during pregnancy and breastfeeding

Notes: Red, contraindicated during pregnancy; blue, no studies on harm to the fetus.

Figure 1 Treatment algorithm for PPCM prepared on the basis of Hilfiker-Kleiner et al.⁸¹

Hilfiker-Kleiner D, Haghikia A, Berliner D, et al. Bromocriptine for the treatment of peripartum cardiomyopathy: a multicentre randomized study. Eur Heart J. 2017;38(35):2671–2679. doi:10.1093/eurheartj/ehx355

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