HeartCenterOnline for Patients
Cardiomyopathy Caused by Pregnancy
http://www.heartcenteronline.com/myheartdr/home/patientstories.cfm?id=923

Notes: Has direct link to PeriPartum Cardiomyopathy. They have a community and a place to submit your own story. Info on pregnancy and Heart failure. They have “ask a Cardiologist”. Lots of info. On CHF, palpitations, tests, procedures, etc. Sample submission of story is below.

 PATIENT STORIES
Cardiomyopathy caused by pregnancy
I recently delivered my third baby boy. He is a pure joy and I thank god every day for bringing him into my life. My pregnancy with him was pretty typical in the beginning. About 25 weeks I started having a lot of palpitations. Both my ob doctor and primary care doctor assured me that this was pregnancy related and nothing to worry about. I kept on going and basically ignoring my symptoms until I ended up fainting. I again called my doctors and was told to go to the ER. The doctor there told me that it was pregnancy related syncope and not to worry about it ......."

The New England Journal of Medicine
http://content.nejm.org/
Did a “Search on PeriPartum Cardiomyopathy and had a lot of reslults. The URL of the results is below. I have also copy and pasted the results under the URL.**I found this to be a very reliable source of info. And I also found that if you ask your doctor or cardiologist they will give you a password to read ALL the archied articles in their intirety.**

My search link
1. Maternal and Fetal Outcomes of Subsequent Pregnancies in Women with Peripartum Cardiomyopathy Identification of a Gene Responsible for Familial Wolff–Parkinson–White Syndrome Full Text N Engl J Med 2001; 345:552, Aug 16, 2001. Corrections

2. Maternal and Fetal Outcomes of Subsequent Pregnancies in Women with Peripartum Cardiomyopathy Elkayam U., Tummala P. P., Rao K., Akhter M. W., Karaalp I. S., Wani O. R., Hameed A., Gviazda I., Shotan A. Abstract | Full Text  N Engl J Med 2001; 344:1567-1571, May 24, 2001. Original Articles

3. Peripartum Cardiomyopathy Reimold S. C., Rutherford J. D. Full Text N Engl J Med 2001; 344:1629-1630, May 24, 2001. Editorials

4. Underlying Causes and Long-Term Survival in Patients with Initially Unexplained Cardiomyopathy Felker G. M., Thompson R. E., Hare J. M., Hruban R. H., Clemetson D. E., Howard D. L., Baughman K. L., Kasper E. K. N Engl J Med 2000; 342:1077-1084, Apr 13, 2000. Original Articles

5. Peripartum cardiomyopathy Homans D. C. N Engl J Med 1985; 312:1432-1437, May 30, 1985. Original Articles

6. Peripartum cardiomyopathy N Engl J Med 1983; 308:399-400, Feb 17, 1983. Correspondence

7. Peripartum cardiomyopathy due to myocarditis Melvin K. R., Richardson P. J., Olsen E. G., Daly K., Jackson G. N Engl J Med 1982; 307:731-734, Sep 16, 1982. Original Articles

11. Myocarditis and Cardiomyopathy Associated with Clozapine Use in the United States La Grenade L., Graham D., Trontell A. Full Text N Engl J Med 2001; 345:224-225, Jul 19, 2001. Correspondence

12. Maternal and Fetal Outcomes of Subsequent Pregnancies in Women with Peripartum Cardiomyopathy Elkayam U., Tummala P. P., Rao K., Akhter M. W., Karaalp I. S., Wani O. R., Hameed A., Gviazda I., Shotan A.Abstract | Full Text N Engl J Med 2001; 344:1567-1571, May 24, 2001. Original Articles

13. Peripartum Cardiomyopathy Reimold S. C., Rutherford J. D.Full Text N Engl J Med 2001; 344:1629-1630, May 24, 2001. Editorials

14. Platelets, Thrombosis, and the Vessel Wall Marcus A. J. Full Text  N Engl J Med 2001; 344:1560, May 17, 2001. Book Reviews

15. Coexistence of Hypertrophic Cardiomyopathy and Fibromuscular Dysplasia of the Superior Mesenteric Artery Safioleas M., Kakisis J., Manti C. Full Text  N Engl J Med 2001; 344:1333-1334, Apr 26, 2001. Correspondence

16. ABO-Incompatible Heart Transplantation in Infants West L. J., Pollock-Barziv S. M., Dipchand A. I., Lee K. J., Cardella C. J., Benson L. N., Rebeyka I. M., Coles J. G. Abstract | Full Text  N Engl J Med 2001; 344:793-800, Mar 15, 2001. Original Articles

17. Arrhythmias and Sudden Death in Athletes Crampton R. Full Text N Engl J Med 2001; 344:535, Feb 15, 2001. Book Reviews

18. Prognostic Value of Left Ventricular Hypertrophy in Hypertrophic Cardiomyopathy Fatkin D., Graham R. M., Spirito P., Maron B. J. Full Text N Engl J Med 2001; 344:63-65, Jan 4, 2001. Correspondence

19. Mutations in Sarcomere Protein Genes as a Cause of Dilated Cardiomyopathy Kamisago M., Sharma S. D., DePalma S. R., Solomon S., Sharma P., McDonough B., Smoot L., Mullen M. P., Woolf P. K., Wigle E. D., Seidman J.G., Seidman C. E. Abstract | Full Text N Engl J Med 2000; 343:1688-1696, Dec 7, 2000. Original Articles

20. Medical Progress: Myocarditis Feldman A. M., McNamara D. Full Text N Engl J Med 2000; 343:1388-1398, Nov 9, 2000. Review Articles

PPCM and Pregnancies http://meltingpot.fortunecity.com/malaysia/375/pregnant.html
Not much info, Just personal stories. I see Zora’s story! Said for more info become a member but the site was not responding. (Brandy's note: This is Kim's old site, the site is now closed)

Peripartum Cardiomyopathy: Regional Blockade, Lenore George http://www.manbit.com/oa/c41.htm

**Has a lot of info. No real link however. But gives plenty of references for research! ** Peri-partum Cardiomyopathy (PPCM) is a relatively rare disease estimated to occur in 1 in 3000- 4000 pregnancies (1). Criteria for diagnosis include: 1. Development of cardiac failure in the last trimester of pregnancy or within five months of delivery, 2. absence of a determinable aetiology for the cardiac failure, and 3. absence of demonstrable heart disease prior to the last month of pregnancy (2). The diagnosis therefore, is largely one of exclusion as the disease has no pathognomic features (3, 4). The aetiology of PPCM remains poorly understood with theories generally centred upon viral infection triggering autoimmune mechanisms in susceptible individuals (1, 2, 4) Considerations for regional anaesthesia in these patients are similar to those withother causes of heart failure. With regard to anaesthesia for caesarean section, general anaesthetic techniques involve either cardiodepressant drugs such as thiopentone and the inhalational anaesthetic agents, or high dose narcotic techniques, which, while they maintain haemodynamic stability, may necessitate post-operative ventilation for both mother and infant. Further considerations with narcotic techniques are the less well defined endpoint at induction of anaesthesia, which may increase the risk of aspiration of gastric contents in this susceptible population. The management of a failed intubation may also be complicated by the longer acting nature of these drugs and the difficulty with mask ventilation that may occur. Epidural anaesthesia offers several advantages in addition to avoiding these problems. Anaesthesia may be induced in a gradual and controlled manner and if a pulmonary artery catheter is used to guide fluid and inotrope requirements, minimal change in haemodynamic parameters can be achieved. Small bolus doses or an incremental infusion of bupivacaine 0.5% with fentanyl 4-5 mcg/ml is suitable for these purposes. In addition, major neuraxial blockade may actually improve myocardial performance by reducing the afterload on the left ventricle without impairing contractility, although not all authors agree (6). References: 1. Veille JC. Periparturn Cardiomyopathy - A Review. Am J Obstet Gynecol 148;805-818, 1984.

2. Demakis JG Rahimtoolas SH. Peripartum Cardiomyopathy. Circulation 44; 964 968, 1971. 3. Demakis JG. Rahimtoolas SH. Sutton GS et al Natural Course of Peripartum Cardiomyopathy. Circulation 44; 1053-1061, 1971 4. Julian DG, Szekely P. Peripartum Cardiomyopathy Progress in Cardiovasc. Diseases 27; 223-240, 1985. 5. Sanderson JE, Olsen EGJ. Gatei D. Peripartum Heart Disease: An Endomyocardial Biopsy Study. Br. Heart J. 56; 285-91, 1986. 6. Brown G, O'Leary M, Douglas I, Herkes R Perioperative Management of a Case of Severe Peripartum Cardiomyopathy. Anaesth. Intens. Care 20; 80-83, 1992. 7. Hutchinson RC, Ross AW, Severe Peripartum Cardiomyopathy. Anaes. Int. Care. 20; 398 (correspondence) 1992. 8. Scott JR, Wagoner LE, Olsen S. Pregnancy in Heart Transplant Recipients. Management and Outcome. Obstet & Gynecol. 82; 324-327, 1993. 9. Hughes R, Kapur P, Sutton GC, et al A case of fatal Peripartum Cardiomyopathy. Br Heart Jn. 32; 272-276, 1970. 10. Homans DC. Current Concepts. Peripartum Cardiomyopathy NEJM 312; 1432 1437, 1985. 11. Wesley L, Cotton DB. Peripartum Cardiomyopathy: Current Concepts and Clinical Management. Clinical Obstets Gynecol. 20; 54-67, 1989.

Welcome to Med Help International  A not-for-profit organization http://medhelp.org/perl6/cardio/messages/30163a.html
**All in al seems like a good place to ask questions of a cardiologist and tell your story. Also gives links to information on PPCM and concerns.**
Questions in The Heart Forum are being answered by doctors from The Cleveland Clinic Heart Center, consistently ranked the #1 Heart Center in America.

Heart Health & Pregnancy
http://pregnancy.about.com/cs/hearthealth/index.htm
**Seems to have some good info and resources on PPCM. I also think I found Cara’s story on this one, at least I think it was her!**
Heart Health & Pregnancy Guide picks What you need to know about your heart and common heart related problems during pregnancy.

THERE ARE TWO LINKS IN THIS PAGE:
Peripartum Cardiomyopathy
Learn about PPCM signs and symptoms.
Peripartum Cardiomyopathy
Learn about PPCM in pregnancy and hear from other women, particularly in
relation to subsequent pregnancy.

Texas Heart Institute
http://www.tmc.edu/thi/dilated.html
Pregnancy and childbirth
In rare cases, a woman may develop heart muscle disease late in pregnancy or during the first few months after she has had her baby. This is called peripartum cardiomyopathy. With or without having had a viral or bacterial infection, her heart muscle may become inflamed. Researchers have not been able to find out why this happens. They do know that if the woman gets over the disease and becomes pregnant again, she is again at risk for developing the condition. Also, in the United States, black women develop peripartum cardiomyopathy more often than women of other races.

JAMA Clinical Cardiology Peripartum Cardiomyopathy  
National Heart, Lung, and Blood Institute and Office of Rare Diseases
http://jama.ama-assn.org/issues/v283n9/ffull/jcc90005.html
Peripartum Cardiomyopathy: National Heart, Lung…This site was very resourseful! A lot of info. I didn’t have time to read all the way through it but what I did read had a lot of info on just PPCM.

eMedicine.com
http://www.emedicine.com/med/byname/cardiomyopathy-peripartum.htm
Very iformative. For more further detail must register, but its FREE!

GASNet Survey of Anesthesiology: December 2000 -
J.A.M.A., 283: 1183-1188, 2000
http://gasnet.med.yale.edu/sa/2000/06/03.php
SPECIAL NOTE ABOUT ONE OF THE CO-AUTORS: One of the authors of this of this article used to be part of OUR Dr. James Fett! This is an exact quote from Dr. Fett regarding Jean Claud Veille: “Jean Claud Veille, MD, who used to be on our PPCM study group out of Emory University. I have lost touch with him over the past two years.” Therefore its worth some reading.

Karen Yontz Women's Cardiac Awareness Center
http://www.karenyontzcenter.org/healthwise/phys_corner/phys_cor_armaganian.htm
The Karen Yontz Heartline 1-800-788-8380
PERIPARTUM CARDIOMYOPATHY (PPCM): Signs  Symptoms  Treatment
Lisa L. Armaganian, M.D.

OBGYN.net
Risk Of Heart Failure Relapse Need Not Deter Some Women From Pregnancy Obstetrics
http://www.obgyn.net/newsrx/womens_health-Obstetrics-20010614-25.asp
This site provides factual current studies on pregnancy after ppcm. It’s not all good news or bad news either. But it is truthful info women are looking for when trying to make the decision of future pregnancies.

E-medicine: Instant Access to the Minds of Medicine
http://www.emedicine.com/med/topic292.htm
More Info on PPCM

Health Nexus
http://www.health-nexus.com/peripartum_cardiomyopathy.htm
This site describes a rare heart condition affecting women called peripartum cardiomyopathy.

www.pubmed.com
added my Makoul

www.heart-help.net
This site is wonderful, with messageboard & everything!

www. rebeccaanne.com
a tribute to a beautiful women who lost her battle with PPCM

www.chfpatients.com
Before the PPCM site, Jons place gave me much comfort.

http://www.homestead.com/ausable/cardio.html
One woman's account of PPCM

Avera Health
Another basic site about PPCM with some older statistics

Cardiomyopathy Center
An entire site filled with information about the heart muscle

Yahoo Health
Another basic site on PPCM

MyCHF.com
Informative, but a bit boring.

Cardiomyopathy Association
A place devoted to the heart, not a lot of info on PPCM though