Miocardiopatía periparto / Peripartum cardiomyopathy

Agosto 18, 2017. No. 2784

La miocardiopatía periparto como causa de insuficiencia cardiaca en el embarazo y el puerperio Margarita Gallardo Arozena, Tania de Ganzo Suarez, Beatriz Contreras Gonzalez, Ivan Bernaldo de Quiros Huguet, Nieves Sierra Medina y Domingo Mendez Mora Prog Obstet Ginecol. 2015;58(8):363-367 Resumen La miocardiopatía periparto es una enfermedad con una elevada morbimortalidad y que, a pesar de sus riesgos potenciales, no es posible prevenirla. Por ello, solo podremos actuar sobre los factores de riesgo asociados a su aparición y sobre las complicaciones una vez diagnosticada. Debido a su baja incidencia, es difícil el conocimiento real de esta enfermedad, ya que se basa en artículos publicados sobre series reducidas de casos. El propósito de esta revisión es realizar una descripción de la fisiopatología, las manifestaciones clínicas, el diagnóstico y el tratamiento de la enfermedad, enfocada principalmente en el manejo obstétrico de la gestante PDF Tratamiento práctico de la cardiomiopatía periparto Practical management of peripartum cardiomyopathy. Kim MJ1, Shin MS2. Korean J Intern Med. 2017 May;32(3):393-403. doi: 10.3904/kjim.2016.360. Epub 2017 Apr 14. Abstract Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy that causes systolic heart failure (HF) in previously healthy young women. Despite latest remarkable achievement, unifying pathophysiologic mechanism is not well established. Considering close temporal relationship to pregnancy, the recent prolactin theory is promising. Abnormal short form of 16-kDa prolactin may be produced in the oxidative stress milieu, show anti-angiogenic effect and damage cardiovascular structure in late pregnancy. Future study is needed to determine whether abnormal prolactin system is useful as a biomarker for diagnosis and therapy of PPCM. Diagnosis is made based on the finding of left ventricular systolic dysfunction after excluding other causes of HF. A multidisciplinary team approach is essential for acute HF, antepartum, labor and postpartum care. Recovery from left ventricular dysfunction is critical for prognosis. As PPCM can recur and cause serious clinical events, subsequent pregnancy is not recommended. This review focuses on the practical management of PPCM. KEYWORDS: Cardiomyopathies; Heart failure; Peripartum cardiomyopathy; Pregnancy PDF Miocardiopatía periparto Peripartum Cardiomyopathy. Arany Z1, Elkayam U2. Circulation. 2016 Apr 5;133(14):1397-409. doi: 10.1161/CIRCULATIONAHA.115.020491. Abstract Peripartum cardiomyopathy is a potentially life-threatening pregnancy-associated disease that typically arises in the peripartum period and is marked by left ventricular dysfunction and heart failure. The disease is relatively uncommon, but its incidence is rising. Women often recover cardiac function, but long-lasting morbidity and mortality are not infrequent. Management of peripartum cardiomyopathy is largely limited to the same neurohormonal antagonists used in other forms of cardiomyopathy, and no proven disease-specific therapies exist yet. Research in the past decade has suggested that peripartum cardiomyopathy is caused by vascular dysfunction, triggered by late-gestational maternal hormones. Most recently, information has also indicated that many cases of peripartum cardiomyopathy have genetic underpinnings. We review here the known epidemiology, clinical presentation, and management of peripartum cardiomyopathy, as well as the current knowledge of the pathophysiology of the disease. KEYWORDS: cardiomyopathies; heart failure; pre-eclampsia; pregnancy PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información/Information Videoclip

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Cardiopatía periparto / Peripartum cardiomyopathy

Agosto 20, 2017. No. 2786

Cardiopatía periparto. Una revisión sistemática Peripartum Cardiomyopathy: A Systematic Review Viviana Aursulesei and Mihai Dan Datcu PDF Cardiopatía periparto desde una perspepectiva genética Peripartum Cardiomyopathy From a Genetic Perspective. Kamiya CA1, Yoshimatsu J, Ikeda T. Author information Circ J. 2016 Jul 25;80(8):1684-8. doi: 10.1253/circj.CJ-16-0342. Epub 2016 Jul 6. Abstract Peripartum cardiomyopathy (PPCM) is a rare, but life-threatening condition that occurs during the peripartum period in previously healthy women. Although its etiology remains unknown, potential risk factors include hypertensive disorders during pregnancy, such as preeclampsia, advanced maternal age, multiparity, multiple gestation, and African descent. Several cohort studies of PPCM revealed that the prevalence of these risk factors was quite similar. Clinically, approximately 40% of PPCM patients are complicated with hypertensive disorders during pregnancy. Because PPCM is a diagnosis of exclusion, heterogeneity is a common element in its pathogenesis. Recent genetic research has given us new aspects of the disease. PPCM and dilated cardiomyopathy (DCM) share genetic predisposition: 15% of PPCM patients were found to have genetic mutations that have been associated with DCM, and they showed a lower recovery rate. Other basic research using PPCM model mice suggests that predisposition genes related to both hypertensive and cardiac disorders via angiogenic imbalance may explain common elements of hypertensive disorders and PPCM. Furthermore, hypertensive disorders during pregnancy are now found to be a risk factor of not only PPCM, but also cardiomyopathy in the future. Understanding genetic variations allows us to stratify PPCM patients and to guide therapy. (Circ J 2016; 80: 1684-1688). PDF Reducción fisiológica de la función contráctil del ventrículo izquierdo en mujeres postparto sanas: Posible superposición con miocardiopatía periparto. Physiological Reduction in Left Ventricular Contractile Function in Healthy Postpartum Women: Potential Overlap with Peripartum Cardiomyopathy. Khan SG1,2, Melikian N1,2, Mushemi-Blake S1,2, Dennes W3, Jouhra F2, Monaghan M1,2, Shah AM1,2. Author information PLoS One. 2016 Feb 9;11(2):e0147074. doi: 10.1371/journal.pone.0147074. eCollection 2016. Abstract AIMS: Peripartum cardiomyopathy is a potentially life-threatening cause of heart failure, commoner in Afro-Caribbean than Caucasian women. Its diagnosis can be challenging due to physiological changes in cardiac function that also occur in healthy women during the early postpartum period. This study aimed to (i) establish the overlap between normal cardiac physiology in the immediate postpartum period and pathological changes in peripartum cardiomyopathy ii) identify any ethnicity-specific changes in cardiac function and cardiac biomarkers in healthy postpartum women. METHODS AND RESULTS: We conducted a cross-sectional study of 58 healthy postpartum women within 48 hours of delivery and 18 matched non-pregnant controls. Participants underwent cardiac assessment by echocardiography and strain analysis, including 3D echocardiography in 40 postpartum women. Results were compared with 12 retrospectively studied peripartum cardiomyopathy patients. Healthy postpartum women had significantly higher left ventricular volumes and mass, and lower ejection fraction and global longitudinal strain than non-pregnant controls. These parameters were significantly more impaired in peripartum cardiomyopathy patients but with overlapping ranges of values. Healthy postpartum women had higher levels of adrenomedullin, placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt1) compared to controls. The postpartum state, adrenomedullin, sFlt1 and the sFlt1:PlGF ratio were independent predictors of LV remodelling and function in healthy postpartum women. CONCLUSION: Healthy postpartum women demonstrate several echocardiographic indicators of left ventricular remodelling and reduced function, which are associated with altered levels of angiogenic and cardiac biomarkers. PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información/Information Videoclip

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org