"Peripartum cardiomyopathy is defined as cardiomyopathy developing in the last month of pregnasncy or the first 6 months postpartum in a woman without previous disease and after exclusion of other causes of cardiac failure. It is therefore a diagnosis of exclusion that should not be made without a concerted effort to identitfy valvular, metabolic, infectious, or toxic causes of cardiomyopathy............. The incidence of peripartum cardiomyopathy is estimated at betweeen one in 1500 and one in 4000 deliveries in the US. An incidence as high as 1% has been suggested in women of certain African tribes. However, idiopathic heart failure in these women may be primarily a result of ujnnusual culturally mandated peripartum custums involving excessive sodium intake and may represent as, as such, simple fluid overload. (interesting!) In the US, the peak incidence of peripartum cardiomyopathy occurs in the second postpartum month and appears most frequently among older, multiparous black females. Other suggested risk factors include twinning and pregnancy-induced hypertensiln.In some cases, a familial recurrence pattern has been reported. The condition is manifest clinically by increasing fatigue, dyspnea (shortness of breath), and peripheral or pulmonary edema. Physical examination reveals classic evidence of congestive haeart failure. including jugular venous distentioon. rales, and an S2 gallop. Cardiomegaly and pulmonary edema are found on chest x-ray, and the electrocardiogran............Overall mortality ranges from 25% to 50%.........Because of the nonspecific clinical and pathologic nature of perpartum cardiomypathy, it's existance as a distinct entiry is supported primarily by epidemiologic evidence suggesting that 80% of cases of idiopathic cardiomyopathy in women of chicldbearing age occur in the perpartum period. Such aN epidemio;ogical distribution could also bbe attributed to an exacerbation of underlying subclinical cardiac disease related to the hemodynamic changes accompaning normal pregnancy. However, as such changes are maximal in the third trimest of pregnancy and return to normal within a few weeks postpartum, such a pattern does not explain the peak incidence of pc occurring, in most reports, during the second month postpartum ...........Although nutritional, hormonal , and auto immune etiologies all have been sugggest, substantial backing for any of these theories is lacking........Therapy includes digitalization, diuretics, sodium restriction, and prolonged bedrest...... Tends to recur with subsequent pregnancies.....prognosis for future pregnancies related to heart size.....Taken from:Reece,E. Hobbins,J,Mahoney, M, Petrie,H. MEDICINE OF THE FETUS & MOTHER. 1992. J.B> Lippincott Company. Philadelphia. HOpe this helps- Toby ------------------------------------- Name: Toby Gish R.N.LLLL.IBCLC E-mail: Toby Gish <[log in to unmask]> Date: 20/03/96 Time: 03:19:19 PM This message was sent by Chameleon -------------------------------------