? for Dr. Fett

[miachic]

Hi Dr. Fett. First of all, do you know of any good cardiologists or doctors that specialize in PPCM in the Cincinnati/Dayton, Ohio/Northern Kentucky area? I have a WONDERFUL OB who is a Godsend and I really like my cardiologist but would like to find one that specializes in PPCM in case my husband and I decide to try for another baby in a few years.

Also, I was put on metoprolol after being discharged from the hospital to help with my BP, etc. and it got my BP pretty low so they took me off of it. I am not currently taking anything and haven't since that second week postpartum. My EF at one month pp was 30-35%, at three months pp 40-45% and now at 4.5 months pp is 54%. The only thing I've done is improve my diet and exercise pretty regularly, and lost all my preganncy weight and then some. Do you think I still need to be put on a med? The heart failure doctor told me that I would have to be on meds the rest of my life but I would rather not take anything if I don't need to. She didn't seem too open to discussing this and just shot off all her answers to my questions without giving me a chance to really get a word in edgewise once she started talking.

What do you think based on my EF and the fact that I'm asymptomatic and doing everything I normally do? Do I still need a beta blocker? I would rather not take both BB and ACE-I because I'm nursing and don't want to have too many drugs flowing to baby. Just curious. Thanks!

Emily

[JAMESFETT]

Emily, it's great to hear your story and to know you are doing great! PPCM certainly sounds like a correct diagnosis for you, and the course you have had is a most favorable one. Whether or not you should still be on medications is between you and your doctors, and particularly your cardiologist. I tend to be very cautious because I have encountered a number of PPCM patients who relapse if they discontinue too early their medications. For that reason I treat for a minimum of one year, and I always treat initially with an ACE-I plus a B-B (beta-blocker), preferable carvedilol. When I withdraw medications, I first wean off the ACE-I, and last of all the carvedilol, following left ventricular systolic function with echos. Those cardiologists who advise PPCM patients to take B-B "for life" may not be far from the correct path, certainly they have sound arguments. It is also advisable to follow the blood BNP, assuring that stays normal, and a blood hs-CRP, again, looking for values below 10 mg/L. Future pregnancies depend upon normal echos, now a dobutamine stress echo, and normal BNP, hs-CRP plasma levels. Does that help? The nearest PPCM specialists I know for you would be in Chicago (Lindemeyer, Lang), Philadelphia (Dorbala, Brozena) and Rochester Mayo Clinic (Murphy, Cooper). Prayers and best wishes,

JD

[miachic]

Thanks! I just got my BNP checked the other day and it's at 28 right now. I know that's not high but not exactly what I wanted it to be. What do you think of this number? My cardiologist took me off the BB because my BP went a little low (90/low 50s)and he didn't want to keep me that low for fear he'd have to give me something to bring it back up. I'll have to talk with him more about it, especially given what you said. I did read about the dobutamine stress for pre-pregnancy testing. I am going to look into that in a few years. I got a Cardiolite stress (because I'm nursing...no thallium...pumping and dumping is bad enough for two to three days :)) yesterday and everything turned out fine and my heart tolerated everything well with good BP and HR response and good echo pattern. I haven't gotten the official results yet but those are the prelim results from the nurse who called yesterday and I am excited that I have made such great improvement so far.

Thanks for answering!

Emily

[Delores]

Hi Emily. I am only on an ARB. I had concerns about not being on a BB too, but my doctor thinks that it would lower my BP too much. I would like to take Coreg as that seems to be the "miracle" drug a lot of PPCMers use. However, I have asthma, and that bothers my doctor in treating me with a BB. So as of now I am on lasix (diuretic) and Cozar (ARB). Believe me, I want to take anything and everything to imporve my chances of full recovery, but I also trust my doctor in helping me to decide what is in my personal best interest. Good luck on figuring out what road you need to take. You sound as if you are getting better by the day. God bless. You are in my prayers. Delores :)