Wszystkie pacjentki z przebytą PPCM wymagają stratyfikacji ryzyka i poradnictwa dotyczącego przyszłych ciąż (zalecenie klasy I).

Podsumowanie

Z uwagi na rosnącą liczbę ciężarnych kobiet z czynnikami ryzyka schorzeń układu sercowo-naczyniowego lub z już istniejącymi chorobami serca problem HF w ciąży i po porodzie staje się coraz bardziej istotny. Obowiązkiem wszystkich lekarzy opiekujących się pacjentkami spodziewającymi się dziecka jest zwracanie uwagi na objawy mogące sugerować rozwijającą się HF, ponieważ właściwie postawiona diagnoza oraz odpowiednio wcześnie wdrożone leczenie mają kluczowe znaczenie dla rokowania zarówno matki, jak i płodu. Etiologia okołoporodowej HF jest zróżnicowana. Właściwie przeprowadzona diagnostyka różnicowa ma wpływ nie tylko na dobór odpowiedniego leczenia, lecz także na rokowanie odległe oraz poradnictwo dotyczące przyszłych ciąż. Stratyfikacja ryzyka oraz postępowanie w ciąży/w okresie okołoporodowym u kobiet ze zdiagnozowaną strukturalną chorobą serca oraz HF w wywiadzie są złożone i wymagają zaangażowania wielodyscyplinarnego zespołu. Kobiety, które przebyły chemio-/radioterapię z powodu raka lub nowotworu układu krwiotwórczego, wymagają szczegółowej oceny i poradnictwa przed ciążą.

ABSTRACT

Heart failure during and after pregnancy and peripartum cardiomyopathy

Heart failure (HF) is the leading cause of morbidity and mortality in pregnant women in developed countries. Peripartum cardiomyopathy (PPCM) is a potentially life-threatening condition that typically presents as heart failure with reduced ejection fraction (HFrEF) in the third trimester of pregnancy or in the first 6 months after delivery in women without another known cause of heart failure. Given that shortness of breath, fatigue and leg edema are common in the peripartum period, a high suspicion score is required to avoid a misdiagnosis. A delayed diagnosis and implementation of appropriate treatment for HF can lead to subsequent complications, including worsening of long-term prognosis in patients with a new onset of HF. Tests for natriuretic peptides, electrocardiography and echocardiography are recommended to promptly diagnose or rule out heart failure. Important differential diagnoses include pulmonary embolism, myocardial infarction, hypertensive heart disease during pregnancy as well as pre-existing heart disease. PPCM is associated with high morbidity and mortality as well as often not full recovery. The use of guideline-directed pharmacological therapy for HFrEF is recommended in all patients while taking into account relevant contraindications during pregnancy and lactation. The important role of education and counselling on contraception and future pregnancies is emphasized.

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