CHALLENGES IN INTENSIVE CARE MANAGEMENT OF PATIENTS WITH PERIPARTUM CARDIOMYOPATHY

Abstract

Pregnancy is associated with significant physiological changes in the cardiovascular system. Among pregnancy-related cardiovascular complications, peripartum cardiomyopathy (PPCM) is a potentially life-threatening condition that develops in otherwise healthy women during the last month of pregnancy or in the first months postpartum. Distinguishing the pathological symptoms of PPCM (fatigue, dyspnea, and edema) from the normal postpartum discomfort experienced by healthy women remains a major challenge. Furthermore, conditions such as preeclampsia, myocarditis, or underlying genetic diseases can present with overlapping symptoms. These diagnostic difficulties, along with the challenge of differentiating PPCM from other pregnancy-associated pathologies, may explain why the condition is still underdiagnosed. In addition, the underlying pathophysiology is incompletely understood, reliable biomarkers are scarce, and therapeutic options remain limited. Long-term prognosis, treatment strategies, and experience with subsequent pregnancies are only beginning to emerge.

This review focuses on new aspects of physiological and pathophysiological changes in the maternal cardiovascular system during pregnancy, by comparing normal pregnancy conditions with hypertensive complications, genetic factors, and infectious diseases. It also presents current clinical and basic science knowledge on PPCM, places it in context, and highlights promising new concepts in diagnostic tools, therapeutic approaches, and management.