Peripartumkardiomyopati: fruktad diagnos som ofta missas. Klarlagd etiologi öppnar för specifik behandling
Sammanfattning
Peripartumcardiomyopathy an often missed diagnosis
Peripartumcardiomyopathy is defined as a heart failure with onset from late pregnancy up to five months after delivery. The diagnostic criteria include no previous history of heart failure and decreased systolic function verified by echocardiography. Symptoms may be shortness of breath but malignant cardiac arrhytmias may also occur. Some patients require heart transplantation and antiarrhytmic device implantation. Mortality was previously 40 % but it has recently been reported to be only 1 %. Recently it was demonstrated that a cadiotoxic variety of prolactine may trigger the disorder. In a small study the inhibition of prolactine production with bromocriptine showed a positive effect. These results need to be confirmed. In Sweden some 30 to 50 cases can be expected annually and 3 to 5 of these patients may be critically ill. Since delayed diagnosis is a prominent feature it is important that physicians who might see these patients are aware of the possibility of peripartumcardiomyopathy.