Severity of PPCM Question for Dr. Fett

[MrsEener]

Dr Fett,

Are there any ideas as to why some women get mild PPCM and some get severe and anywhere in between?

Does there seem to be any correlation between the severity and things that a woman has some amount of control over like for instance diet (like salt intake for example), exercise, weight (bmi or whatever), lifestyle (stressful or not so stressful)?

Or correlation with other things like age, number of previous pregnancies (like for example maybe she had an undiagnosed case of PPCM in a previous pregnancy), race, gender (;) just kidding), immune system?

Thanks.

[JAMESFETT]

Each individual's immune system is different; thus, some will be more severely affected than others. There are also "stressors" which make heart failure symptoms worse, such as pregnancy-induced hypertension (PIH), anemia, older age, multiparity (5 or more pregnancies). In some cases there may have been a very mild, undiagnosed PPCM with a previous pregnancy, and thus it appears worse or earlier in the next pregnancy. Often, the earlier the condition is diagnosed, the milder it appears. That is why it is so important to be aware of heart failure symptoms and to make the diagnosis early before the whole process " snowballs" into a much worse condition. I consider all very serious, regardless of severity (lower levels of LV EF), and treat the milder forms as vigorously as the more severe, because I fear progression if under-treated or delayed-treated.

JD

[MrsEener]

Each individual's immune system is different; thus, some will be more severely affected than others. There are also "stressors" which make heart failure symptoms worse,
JD

I'm sorry, can you clarify? Are you saying the "stressors" can make just the symptoms worse, or the actual heart failure worse?

Thanks

[JAMESFETT]

With those stressors, the symptoms of heart failure will be worse because the heart failure is worse with the combination of effects. They are not the cause of PPCM, however.

JD

[mikeyandBellesmommy]

With my first PPCM pregnancy I walked around undiagnosed for months, my ef went down to 18%.. I think if it was caught when I first complained of symptoms and before i went through months and then an awful labor it would have been less severe..

With my post ppcm pregnancy i was monitored every two weeks at the end my ef slipped to 40% and it was caught at 35 weeks.. I think if I would have continued on and they did not catch it I would have had more slippage and a more severe case..

[JAMESFETT]

Yes, it is important to closely monitor subsequent pregnancies in PPCM patients because, even in the best of situations, relapses do occur in from 10 to 20 % of subsequent pregnancies. You are very fortunate for the close monitoring your physicians gave you, and fortunately you recovered in spite of the delays in diagnosis with your first pregnancy.

JD