Cardiac complications of pregnancy including peripartum cardiomyopathy
Telling heart failure from normal pregnancy breathlessness, peripartum cardiomyopathy (definition, drugs before and after birth, bromocriptine with LMWH, recovery and next-pregnancy risk), rheumatic mitral stenosis, pregnancy-associated SCAD and aortic dissection, arrhythmias, and planning birth, following the 2025 ESC pregnancy guideline.
Tier 2Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Cardiac disease is a leading indirect cause of maternal death in Australia and other high-income countries. Many women had no known heart disease before pregnancy.
- Normal pregnancy mimics heart failure: breathlessness, oedema, a flow murmur, a third heart sound. Orthopnoea, PND, tachycardia at rest, crackles and a raised JVP are not normal.
- Peripartum cardiomyopathy (PPCM): LVEF under 45% late in pregnancy or after birth, no other cause.
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Sources
- 2025 ESC Guidelines for the management of cardiovascular disease and pregnancyDe Backer J, Haugaa KH et al. Eur Heart J 2025;46(43):4462-4568, 2025 (replaces 2018; mWHO 2.0; no later version found, November 2026)
- 2025 ESC guidelines for the management of cardiovascular disease and pregnancy: statement of endorsement by the NVVC (summary of the PPCM recommendations)Netherlands Heart Journal 2026, 2026
- Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the ESC Study Group on PPCMBauersachs J et al. Eur J Heart Fail 2019;21:827-43, 2019
- Australian guideline for the prevention, diagnosis and management of acute rheumatic fever and rheumatic heart diseaseAU/NZRHDAustralia (Menzies School of Health Research), 3rd edition, October 2026 update
- National Heart Foundation of Australia and CSANZ Guidelines for the prevention, detection, and management of heart failure in Australia 2018AU/NZNational Heart Foundation of Australia and Cardiac Society of Australia and New Zealand, 2018 (no CSANZ pregnancy-specific position statement found, November 2026)
- Bromocriptine for the treatment of peripartum cardiomyopathy, a multicentre randomized studyHilfiker-Kleiner D et al. Eur Heart J 2017;38:2671-9, 2017
- Clinical outcomes for peripartum cardiomyopathy in North America (IPAC)McNamara DM et al. J Am Coll Cardiol 2015;66:905-14, 2015
- Clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy: an ESC EORP registrySliwa K et al. Eur Heart J 2020;41:3787-97, 2020
- Maternal and fetal outcomes of subsequent pregnancies in women with peripartum cardiomyopathyElkayam U et al. N Engl J Med 2001;344:1567-71, 2001
- Last updated
- 14 November 2026
What changed
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