Hadn't ever encountered this problem, so got searching
Can occur late in pregnancy (last month or so) and up to first 5 months postpartum.
Main risk factors: Multiparity, advanced maternal age, gestatational hypertension, preeclampsia, black race and geography, also mentioned Prolactin cleavage (???)
Bhattacharyya, Peripartum Cardiomyopathy, Tex Heart Inst J 2012; 39(1):8-16. Mentions tx includes conventional pharmacologic heart failure therapies. "Therapeutic decisions are influenced by drug-safety profiles during pregnancy and lactation." Overall and excellent article explaining PPCM, Lists 5 meds that require stopping breastfeeding and 7 meds that are compatible (Per AAP-couldn't find year of ref :-( The only 2 mentions of BFing are about compatibility of drugs.
Breiasoulis, Longitudinal systolic strain profiles and outcomes in peripartum cardiomyopathy. Echocardiography 2016; 33: 1354-1360. Says it was first described in 1849! well-known and poorly understood. Geographical varied incidence (possible genetic or viral clue). 1:2500- 1:4000 in US and as high as 1:100 in some Sub-Saharan countries, Haiti. No mention of BFing, except for the risk factor of Prolactin cleavage.
Bruner, Can't Catch Her Breath: Peripartum Cardiomyopathy, Int J Childbirth Edu, 2016; 31(4): 37-39. description of disease and info on counseling moms. No mention of BFing. Some more ref to find :-(
Corbacho, Roles of prolactin and related members of prolactin/growth hormone/placental lactogen family in angiogenesis. J Endocrin, 2002; 173, 219-238.
Discussion of several factors, saying that prolactin can stimulate angiogenesis (growth of new blood vessels) Mostly discussed PRL 16K and was way over my head.
Demir, The Treatment of Heart Failure-Related Symptoms with Ivabradine in a Case with Peripartum Cardiomyopathy. Int Cardiovasc Res J, 2013; 7(1): 33-36.
No mention of BFing, but did discuss the multiple (!) meds used for tx .
Fisher (Dr. Wes) Breast-feeding Hormone Affects the Heart? Blog (Drwes.blogspot.com/2007/12/breast-feeding-hormone-affects-heart) Explanation of the 2 parts of Prolactin (23 kDa0 promotes angiogenesis and cleaved 16kDa disrupts. Bromocriptine blocks bad 16 kDa. Interesting letter in reply from Dr J.D. Felt who says PPCM is like a 1000-piece jigsaw puzzle and we must carefully and fully scrutinize each piece if we want to see the full picture emerge.
Another Point I picked up from 'reading' these articles was that treatment is very varied and involves a number of meds.
Hilfiker-Kleiner, A Cathepsin D-cleaved 16 kDa Form of Prolactin Mediates Postpartum Cardiomyopathy, 2007, Cell 128, 589-600.
" Recovery From Postpartum Cardiomyopathy in 2 Patients by Blocking Prolactin Release With Bromocriptine. JACC, 2007, 50(24) 2354-55
Explanation of a "novel" therapeutic strategy for PPCM. Again moms were given multiple meds, however Bromocriptine seemed to speed recovery.
Khan, Physiological Reduction in Left Ventricular Contractile Function in Healthy Postpartum Women: Potential Overlap with Peripartum Cardiomyopathy.
PLoS ONE(11)2. 2016. Discussed changes in heart function in healthy postpartum women post vag delivery with healthy non pp women.
Robeson, Hemodynamic effects of breast-feeding. 1989, Br J Ob Gyn.96: 1106-08 Studied Lactating and non- lactating women fpr 2 weeks post delivery.
"Breast-feeding was not associated with any significant changes in cardiac output or blood pressure."
Sliwa, Postpartum cardiomyopathy. 2006, The Lancet; 368: 687-693.. Under management discusses the various drugs used and why. They mentioned recent research that discusses risk factors like immunosuppressive drugs, cardiotropic viruses, and viral genomic material.
Of course, each article had lots of references, so CBI will keep looking Pat in SNJ
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