PPCM and virus

[JAMESFETT]

Although having been reported in the medical literature in one group of PPCM patients, definitive answers about the role of viral infection in PPCM will require more endomyocardial biopsies with PCR testing of snap-frozen tissue. The importance and justification for doing such testing exist particularly for those PPCM patients who are not experiencing improvement in the early weeks and months following diagnosis, since emerging new antiviral and immunomodulatory treatments depend upon knowing if virus is present or absent in cardiac tissue. Enhanced imaging studies prior to biopsy may increase the possibility of identifying both inflammation and virus, if present.

--James D. Fett, MD

[JAMESFETT]

Did you know that researchers have found that up to 2/3 (67 %) of patients with (idiopathic) dilated cardiomyopathy (IDCM) have been found to have virus present in their heart biopsies? That included adenovirus, coxsackievirus, parvovirus B19. IDCM is a "first cousin" to PPCM, and may turn out to be the same process.

JDF

[jasper]

Thanks Dr. Fett. At what point should a biopsy be done? I am 18 months out with a questionable IDCM/PPCM diagnosis. I have recovered to an EF of42% so far. Is there any merit in thinking about it at this point or has the damage been done?
I appreciate you and the time and wisdom you offer all of us here!
Jennifer

[JAMESFETT]

Jennifer, I am aggressive in pursuing cath and biopsy of ppcm patients who are not recovering at an expected and hoped-for rate. For one thing, there are now newer treatments available, even if on a modified research basis, beyond the conventional heart failure medications. For another, one wants to be sure there are not findings that would place the dilated cardiomyopathy in another category of causes other than ppcm. And for another, I know of cath, biopsy, and interventions applied even 2 years after diagnosis, with improvements when treated according to findings. So it is something you want to discuss with your physicians, and if they are not convinced or experienced enough, then to seek a referral to a cardiologist who can do cath and biopsy, including polymerase chain reaction testing (PCR) for virus on a "quick-freeze" biopsy tissue. Scanning with gadnolinium enhancement prior to cath may help to identify involved areas with an inflammatory process.

James

[JAMESFETT]

PS to Jennifer. Ideally, this would be done in the first 6 months after diagnosis of PPCM if sufficient improvement has not been registered by 6 months of treatment. Those beyond that, and some are bound to be beyond that time, just taking into account the newer findings that have occurred with time, careful consideration must be given on a case-by-case basis. Complications to cath and biopsy happen, but they are very rare, and some centers do so many of these it is just a matter of routine and prepared for any potential complication.

JDF

[jasper]

Thank you Dr. Fett. I am being treated at UW in Seattle. Do you know of anyone up this way that you would recommend? I go in early Feb next and will ask these questions.
My local cardiologist is very content to just keep the staus quo and have me on meds forever. I guess I need to start at UW and then look for someone who is looking for answers.
I appreciate your input. Happy to have you here for us!
Jennifer

[JAMESFETT]

While there are many excellent cardiologists in western WA, I don't know of anyone who is specifically working on PPCM. I'm sure everything needed could be done here if someone wanted to do it. Right now, living in the Olympic Peninsula, if my dearest friend had PPCM and was not improving I would encurage her to seek out the advice of Joseph Murphy, MD, Cardiologist, Mayo Clinic, Rochester, MN.

JDF

[MissaBaby]

Dr. Fett I looked up this doctor, Joseph Murphy, MD, Cardiologist, Mayo Clinic, Rochester, MN--I didn't see anything about him treating/studying PPCM on the Mayo website. Is this something you personally know about? Is there anything a could read up about him and PPCM on the web?

thanks

[JAMESFETT]

Two areas you could find info regarding the work of Dr. Murphy:

1)Go on web to Entrez Pub Med, in the search page enter "murphy jg" and you will see articles done by him (mostly with me) about PPCM. You can then access the abstracts free of charge.

2)Text: MYOCARDITIS: FROM BENCH TO BEDSIDE , Ed. Leslie T. Cooper Jr, MD, Humana Press, 2003. Chapter 24, "Peripartum Cardiomyopathy" written by Dr. Murphy.

James