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
