Substitute for ACE-inhibitors for PPCM during pregnancy

[JAMESFETT]

When heart failure treatment is necessary for PPCM during the pregnancy (i.e. before delivery) ACE-inhibitors are considered unsafe. Safe-for-pregnancy replacement of ACE-Inhibitors by the combination of nitrates + hydralazine has been demonstrated to be effective, possibly for all ethnicities, but most certainly for African ethnicity. A fixed combination isosorbide dinitrate + hydralazine hydrochloride, called Bidil is available in the combination of 40mg/75mg or 20 mg/37.5 mg. But the two are also available as generic medications much less expensive. We have used the combination for a long time, and generally start with doses of 10 mg isosorbide + hydralazine 25 mg 3 to 4 times daily. Single daily dosing is not available because of the short duration of action that requires multiple dosing during each day.

JDF

[JellyBean's Mom]

Hello ... was just in my cardiologists office last week ... to discuss a second pregnancy post PPCM in 2003. She was scared at the idea. What resources can I tell her about that will help her best help me? I will end up working with a cardiologist, a fertility specialist, a high risk obgyn (who will not handle the delivery) and an obgyn. I have PCOS thus the fertility stuff. Plus had gestational diabetes in 2nd trimester- successfully managed with diet. So I am expecting these issues this time around in addition to PPCM issues. Emergency C-section with 1st child when complaining abt serious breathlessness / some chest constriction + coughing ... no high bp during last pregnancy but the nite of the c-section the bp was through the roof ... diagnosis successfully made a couple days post partum while still in hospital. EF went back up to 50+ within a couple of months. (**** Is this because of the early diagnosis and heart meds?) Initially in hospital was told by original cardiologist and high risk obgyn (in hospital specialist - angel! - who helped diagnose PPCM) and any one else who came around not to ever become pregnant again but since then b/c high EF several high risk OBGYN's and even the original cardiologist have suggested a second go-round ok. However, gynecologist and cardiologist are nervous ... will likely stay on coreg during possible second pregnancy and cardiologist seeking alternative to ace inhibitors. I understand my chances are better with maintained high EF. EF on Nov 2004 = 60-65, May 2005 = 60-65, Feb 2006=60

Anything else I should know about? What resources available to cardiologist and others on medical team? Thanks.

[JAMESFETT]

There are a few good studies on subsequent pregnancy after a diagnsis of PPCM, and those articles are referenced in my reference list under the News red button on home page. Most important factor is full recovery following treatment of PPCM, and that may be further confirmed by doing a dobutamine stress test. Your rapid return to normal does tell me that hour diagnosis was early and your treatment effective. Be sure to check with your ob and pharmacist regarding safety to fetus of Coreg in early pregnancy. Early relapse is always a possibility but in your situation it is less than 10 percent. Early relapse can be detected by monitoring blood CRP (value over 10 mg/liter) and BNP, with followup echo in the event of a rise in either, but a followup echo each trimester. It is good to have the team of doctors watching over you.

JD