Die peripartale Kardiomyopathie (PPCM) ist eine Herzerkrankung, die zuvor herzgesunde Frauen kurz vor oder in den Monaten nach der Entbindung betrifft. In den letzten Jahren konnten Studien zu einem besseren Verständnis der Erkrankung beitragen. Dieser Beitrag bietet einen Überblick über den aktuellen Wissensstand zur Pathophysiologie und dem klinischen Bild der PPCM und fasst die aktuellen Empfehlungen zur Behandlung der PPCM zusammen.
Abstract
Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening heart disease, with onset in the last month of pregnancy or in the first months after delivery in previously heart-healthy women. PPCM patients typically present with heart failure due to left ventricular (LV) dysfunction with an LV ejection fraction (EF) < 45 %. In the last years clinical and experimental studies contributed to a better understanding of the pathophysiology and the clinical course of PPCM. In the context of oxidative stress, the nursing hormone prolactin is cleaved into a smaller antiangiogenic and proapoptotic 16k Da form, leading to myocardial dysfunction. In an animal model this can be prevented by treatment with the dopamine agonist bromocriptine, which suppresses prolactin release. This therapeutic approach was confirmed in several clinical studies. Therefore, the current guidelines recommend a treatment consisting of a heart failure treatment according to current guidelines in combination with the dopamine agonist bromocriptine. If the diagnosis is made early and the treatment is started immediately, the prognosis is good compared to other forms of cardiomyopathies, as LV function recovers in most cases.
In the acute phase the severity of heart failure differs among PPCM patients. Some patients present with mild forms, whereas some PPCM patients display severely reduced LV function and cardiogenic shock. Especially the latter cases are still challenging, as treatment with β1-adrenergic receptor agonists is associated with progression of heart failure and a worse cardiac outcome. Therefore, patients with cardiogenic shock complicating PPCM should be treated in centers experienced in mechanical circulatory support in combination with bromocriptine treatment.
Schlüsselwörter
peripartale Kardiomyopathie - akute Herzinsuffizienz - chronische Herzinsuffizienz
Key words
peripartum Cardiomyopathy - acute heart failure - chronic heart failure
