الفهرس 
Anatomy of the heartOnly 14 pages are availabe for public view
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Abstract
PPCM affects previously healthy women in the final month of pregnancy and up to 5 months after delivery. The diagnosis is based on 4 criteria:
• development of HF in the last month of pregnancy or within 5 months of delivery.
• Absence of an identifiable cause for HF.
• Absence of recognizable heart disease prior to the last month of pregnancy.
• echocardiography (TTE) criteria of left ventricular systolic dysfunction (left ventricular ejection fraction, LVEF <45%), fractional shortening of <30%, or both.
No single explanation of the pathogenesis of PPCM is relevant for all women; the disease has a multifactorial origin such as viral myocarditis, abnormal immune response to pregnancy, maladaptive response to hemodynamic stresses of pregnancy, stress-activated cytokines, excessive prolactin excretion, and prolonged tocolysis and the precise mechanism is still not understood.
Administration of diuretics is indicated in presence of symptoms of fluid retention, inotropic agents used in presence of peripheral hypo-perfusion with or without congestion or pulmonary edema refractory to diuretics and vasodilators. In addition to conventional therapy new lines include milrinone (phospho-diesterase III inhibitor), Levosimendan (calcium sensitizer), bromocriptine, and pentoxifyllin (inhibitor of TNF production). Temporary mechanical circulatory assistance indicated in patients not responding to conventional therapy. This include an intra-aortic balloon pump and a left ventricular assist device, and/or extracorporeal membrane oxygenation.
Several outcomes in PPCM are present. Some women remain stable for long periods, while others get worse slowly. Others get worse very quickly and may be candidates for a heart transplant. Furthermore, the death rate may be as high as 25 - 50%. Persistent cardiomyopathy is associated with poor prognosis.