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The AHA Guidelines and Scientific Statements Handbook of 2009 provides approved treatment for PPCM heart failure, based upon evidence that has documented effectiveness.   Your prescribing cardiologist will be familiar with these guidelines and can give the necessary details.

This AHA Guidelines evidence-based treatment (categories of Class I: ” benefit exceeds risk, should use” and Level of Evidence A:  “data from multiple clinical trials and multiple populations”) for systolic heart failure with decreased LVEF consists in giving tolerable dosages of diuretics, ACE-Inhibitors (replaced by hydralazine with or without nitrates if still pregnant or breastfeeding) and beta-blockers (BB).   

PPCM represents heart failure with reduced left ventricular ejection fraction (LVEF) for which the following treatments "should"  be given, as tolerated:

1.  Diuretics and salt restriction.

2.  Angiotensin converting enzyme inhibitors (ACEI):   should NOT be used during pregnancy due to potential harm to fetus.   During pregnancy, hydralazine, with or without nitrates, may be substituted for ACEI.

3.  Beta-blockers (BB).

4.  Angiotensin II receptor blockers (ARB) for those who are 
     ACEI-intolerant.

Further details are available in the Guidelines.  Please ask your cardiologist about this.

Those PPCM patients who have improved but who remain in the LVEF 0.35 – 0.50 range 6 months or more after diagnosis are a special challenge.  If maximum tolerated dosages of ACEI + BB have not yet been reached, careful titration upwards of dosages may be helpful during this “window of opportunity” for additional recovery.   Very slow incremental dosages can almost always be tolerated, the major limiting factor being postural blood pressure symptoms. 

Earlier evidence from South Africa that the old drug, pentoxifylline (Trental), could be of help in acute PPCM could not be substantiated in clinical trials in Haiti.  This treatment is not recommended.

The effectiveness of bromocriptine, as an inhibitor of the lactating hormone, prolactin, and its potentially cardio-toxic metabolite, 16kDa-prolactin, is currently being evaluated.   See the "Recent Publications" tab on this web-site for the most recent article about these trials.   At this point, it is uncertain that benefits exceed risks; so the use of bromocriptine is not recommended, pending additional clinical trials under research protocol.   ---James D. Fett, MD, 18 July 2013.

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