scarring

[Deb]

Dr. Fett,
How can you tell the difference between scarring on the heart from a first or second pregnancy, versus scarring from a virus or some other cause?

I'm just wondering, that since the doctor's feel my cardiomyopathy pre-existed at least my fourth pregnancy, how do they know it wasn't from one of the earlier pregnancies? Wouldn't it then be PPCM?

Just trying to understand this whole thing....

[JAMESFETT]

Unable to know in that situation. Because most women do not have an echo done before pregnancy, either the first or subsequent, one cannot be absolutely sure that the cardiomyopathy did not preceed the pregnancy or, in the case of a second or more pregnancy when PPCM diagnosed, that the PPCM did not actually start in a first pregnancy. Doing an echo before pregnancy or early in pregnancy in everyone is not "cost-effective" in situations where the incidence of PPCM is low, such as the USA with 1 case per 3000 to 4000 births; but it would be cost-effective in situations where the incidence of PPCM is high, such as in Haiti with 1 case per 300 births. You could have had your cardiomyopathy start with an earier pregnancy. Or it could have started with an earlier viral myocarditis outside of pregnancy that was sub-clinical (not enough symptoms to lead to diagnostic investigation). One of the leading theories is still that PPCM is a post-viral myocarditis with a pregnancy-association of the initial or re-activated virus. If this turns out to be the case it will not be different from post-viral myocarditis cardiomyopathy in anyone, except for the pregnancy-association. I hope I made that clear?

JD

[JAMESFETT]

A virus could trigger the process, but the process has many "actors" that participate, including those you mention. All could play a role, some as instigators, some as mediators. I am quite sure prolactin is not a cause of PPCM, but it may have a role in the immune system adjustments. I don't think a repeat CT scan would give much helpful information.

JD