there is a condition called postpartum cardiomyopathy or peripartum cardiomyopathy we use those two terms synonymously and essentially it is heart failure or an abnormal heart that is diagnosed within the constructs of of pregnancy and childbirth so and specifically it's anyone who develops heart failure symptoms within the last month of pregnancy or within the first five months after pregnancy we term that a postpartum cardiomyopathy and is it like a common condition or is it rare no it's actually relatively uncommon so i see it commonly because of the nature of what i do as an advanced heart failure cardiologist many of my patients have this condition but if you look at all the women out there that are pregnant it's relatively uncommon so it's not something that most general practitioners are going to think about on a regular basis and what you know what are the symptoms the common symptoms of this so the common most common symptoms for any heart failure patient are going to be symptoms of congestion and when i say congestion i mean excess fluid or fluid retention so patients get swollen short of breath abdominal distension inability to finish meals inability to lay flat exertional intolerance you know someone who used to be able to walk up the flight of steps and have no problem now they have to stop while they're walking up a flight of steps because they're so short of breath so those things would all be very typical of congestive heart failure the struggle with with a postpartum or periparting cardiomyopathy is that many pregnant women have those symptoms and it's just a symptom of the pregnancy and so it is a challenge for many people to become diagnosed with this particularly in that last month or so pregnancy but once the baby is delivered if those symptoms are persisting that should raise the index of suspicion for something being abnormal or pathologic yes because she also she mentioned that she had gone to her doctor and he did he wasn't able to diagnose you're saying it was you know it's just her pregnancy um so is that something that is misdiagnosed well i i don't want to say it's misdiagnosed because it's just it's relatively uncommon and it's just not necessarily thought of you know most women at some point in the pregnancy are gonna be have a little bit of swelling and some shortness of breath and some difficulty lying flat because of the uterus the uterine enlargement so all those things are kind of symptoms of pregnancy themselves and they certainly can overlap with a postpartum cardiomyopathy um so you know my opinion would be anyone that's having persistent symptoms that are suggestive that maybe it's something more than just the pregnancy that's something that needs to be thought about and is it something that is it something that's curable is it treatable excellent question so all forms of cardiomyopathy are diagnosed early enough we can get them on excellent medical regimens and many times the heart becomes normal again and so off most oftenly um or most commonly when we diagnose this condition the heart is weak so it's not pumping normally a normal ejection fraction which is just a marker we use to quantify the strength of the heart is going to be in the range of 55 to 60 percent and oftentimes when we don't diagnose a postpartum cardiomyopathy the ejection fraction might be down in the 25 to 30 percent range so about half of normal we put these patients on meds and very commonly almost as a rule if the patient's taking the meds and we diagnose them early enough we can strengthen that heart and we do an echocardiogram down the road and the hearts actually recovered significantly and so that's the goal most patients if they get diagnosed and treated early enough they can get on the right medications and the heart strengthens the other thing that becomes important is making a genetic diagnosis so many of these patients we're learning now not only do they have the stress of the pregnancy but they also have a underlying genetic abnormality and it's that genetic abnormality that was the underlying substrate and the stress of the pregnancy is what actually made the heart get weak and so if if you're not referred to an advanced heart fair cardiologist or someone who's thinking about the genetics of this condition you might not get the opportunity to do a genetic diagnosis we're making many genetic diagnosis a titan mutation in particular is one that we find that's very common and that has implications not only for the mother or the patient but also the child because if it's a genetic diagnosis the mother can potentially pass it on to the child too and um is that something that does happen that you've seen happen where it's passed down yeah yeah many cardiomyopathies that i see particularly in patients with young ages if you do a genetic screen or take a detailed family history these patients will have family members that are affected as well it's autosomal dominant meaning they're they're usually 50 chance that if a parent has it they can pass it on to a child and um is this something so if a woman um you know has this condition has her child gets better is it recommended that she has another pregnancy will this affect her so if the rec recommend recommended is an interesting word choice so there's there's risks of course so there's risks of uh if a woman has a peripheral cardiomyopathy and the heart gets weak at the first child there's certainly risk of the second child and so what we do is we try to inform women of these risks to make sure that they're making informed decisions um at the time of possible second child worth you know i i would never say a woman could never have another child but there's certainly elevated risk and you know i know it's this month is heart month so how can women or even men you know how can they look out for themselves and you know what like what can they do to keep their heart healthy or great you know take care so the the the simple things actually do work so balanced diet regular exercise of physical activity monitoring your weight those things do work you know obesity is a risk factor for heart failure high blood pressure is a risk factor for heart failure development um so anything that we can control and modify to improve our overall health will decrease the risk of heart failure and increase our heart health um and then beyond that if you know many many times what i see is patients that had symptoms for a significant amount of time before they seek medical attention and so i see patients in the hospital in the emergency room that are very sick by the time they come to uh medical attention and so what i would urge patients to do uh if they're if someone's not feeling well and there's something that's clearly abnormal or your loved one tells you you're not breathing right why are you so swollen why are you so short of breath you can't even walk from the parking lot to the grocery store anymore something's wrong when you hear those types of things i do urge people to seek medical attention because if we diagnose this in the early stage almost always patients do very well over the long term but if we diagnose it in a very late stage those hospitalizations are much more complicated and it's much harder to get patients back to their baseline thank you dr howard is there anything that you know those are all my questions there anything that i didn't ask that would be important for people to know about this condition um i i think i would say that you know heart congestive heart failure and cardiomyopathies are they're very common overall not just peripartum cardiomyopathy but cardiomyopathies in general as we age and sometimes even younger patients they develop abnormal hearts and many patients don't know where or how to find the right treatment and what i want to urge the community to uh understand and appreciate is that we do have the right treatment here there are many centers in atlanta uh that can treat heart failure patients in a way that is world class and that's really what we try to deliver here at wellstar and my colleagues across the city do as well we really try to deliver world-class care for our heart failure patients so if you're a heart failure patient out there and you're not sure if you're on the right medications you're not really doing well you're kind of in and out of the hospital and with a poor quality of life make sure you find the right doctor because the right doctors are out there and and the patients can and should do well we have an obligation as a medical community to give our patients the high quality of care and you know if you just google heart failure at cardiologists in atlanta many many names will pop up there is a specific discipline within cardiology that is specific to heart failure and sometimes that's what a patient needs to do well a heart failure specialist