Sunday, December 29, 2013
Most of you have probably heard about my health issues, but I thought I would post some information on here so that everyone would be on the same page. During my last two months of pregnancy, I had swelling in my legs and hands, was short of breath when going up stairs or with too much activity, and frequently felt tired. Both the doctors and myself assumed it was a normal part of the last couple months of pregnancy. A few days after having the baby, I was having trouble taking a full breath and went back into the hospital. I had fluid on my lungs, and was treated for several days while the doctors tried to figure out what was going on. After testing, the doctors have decided that I developed Peripartum cardiomyopathy. This is an uncommon disorder associated with pregnancy in which the heart dilates and weakens, leading to symptoms of heart failure. It can be difficult to diagnose because symptoms of heart failure can mimic those of pregnancy. Cardiomyopathy is a general term used to describe an abnormality of heart muscle function that can lead to symptoms of heart failure. This heart failure develops in the last month of pregnancy or within 5 months of delivery. The heart pumping function is reduced, with an ejection fraction (EF) less than 45% (mine was 41). Most patients(80%) present within 3 months after delivery, with the minority presenting in the last month of pregnancy(about 10%, which is when I first had symptoms). The underlying cause has not been clearly defined. The major symptoms are those of heart failure and include fatigue, shortness of breath, and fluid retention. Because there is a significant overlap between symptoms related to pregnancy, especially toward the end of the third trimester or after delivery, the diagnosis may be initially missed or delayed. Medications are used to stabilize heart function, to improve blood flow to vital organs, and to reduce fluid overload. Older studies suggested that approximately 50% of patients with PPCM recover normal heart function, 25% have persistently reduced heart function but remain stable on medications, and 25% progress to severe heart failure. More recent research suggests that outcomes of PPCM have improved, with survival rates as high as 90% to 95% with contemporary medical and device therapy. Although early improvement in EF (ie, within the first 3–6 months) predicts a good outcome, some women will have slow, gradual improvement in EF over years. The decision of when to stop medications after the heart fully recovers, usually defined as an EF greater than 50, remains controversial. Most physicians, however, agree that ACE inhibitors and β-blockers should be continued for at least 1 year after normalization of EF. One of the most important questions asked by women with a history of PPCM is whether they can safely get pregnant again. The risk of a subsequent pregnancy depends on the recovery of heart function after the diagnosis of PPCM. For women with persistently reduced EF, there is a substantial risk of recurrent heart failure. For women with recovered EF, the risk is much lower and can be further stratified by a stress echocardiogram. If the EF is normal at rest and increases with stress (eg, normal contractile reserve), the risk of recurrent PPCM or heart failure appears to be minimal. So, right now I am on beta blockers and lasix, and will continue to have appointments with my cardiologist. We will just have to wait and see how my heart recovers and what options we will have. I have been feeling good, if a little tired from taking care of the baby. Thank you all for your help and prayers.