Download PDF
Rev Bras Ginecol Obstet 2016; 38(06): 308-313
DOI: 10.1055/s-0036-1584567
Case Report
Thieme Publicações Ltda Rio de Janeiro, Brazil

Peripartum Cardiomyopathy Treatment with Dopamine Agonist and Subsequent Pregnancy with a Satisfactory Outcome

Tratamento da miocardiopatia periparto com agonista dopaminérgico e subsequente gestação com resultado satisfatório
Maria Adélia Medeiros e Melo
1   Fetal Medicine Service, Maternidade-Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, CE, Brazil
,
Jordão Sousa Carvalho
1   Fetal Medicine Service, Maternidade-Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, CE, Brazil
,
Francisco Edson de Lucena Feitosa
1   Fetal Medicine Service, Maternidade-Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, CE, Brazil
,
Edward Araujo Júnior
2   Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
,
Alberto Borges Peixoto
2   Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
,
Francisco Herlânio Costa Carvalho
1   Fetal Medicine Service, Maternidade-Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, CE, Brazil
,
Regina Coeli Marques Carvalho
1   Fetal Medicine Service, Maternidade-Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, CE, Brazil
› Author Affiliations
Further Information

Publication History

16 January 2016

03 May 2016

Publication Date:
11 July 2016 (online)

   Permissions and Reprints

Abstract

Pathophysiological mechanisms of peripartum cardiomyopathy are not yet completely defined, although there is a strong association with various factors that are already known, including pre-eclampsia. Peripartum cardiomyopathy treatment follows the same recommendations as heart failure with systolic dysfunction. Clinical and experimental studies suggest that products of prolactin degradation can induce this cardiomyopathy. The pharmacological suppression of prolactin production by D2 dopamine receptor agonists bromocriptine and cabergoline has demonstrated satisfactory results in the therapeutic response to the treatment. Here we present a case of an adolescent patient in her first gestation with peripartum cardiomyopathy that evolved to the normalized left ventricular function after cabergoline administration, which was used as an adjuvant in cardiac dysfunction treatment. Subsequently, despite a short interval between pregnancies, the patient exhibited satisfactory progress throughout the entire gestation or puerperium in a new pregnancy without any cardiac alterations. Dopamine agonists that are orally used and are affordable in most tertiary centers, particularly in developing countries, should be considered when treating peripartum cardiomyopathy cases.

Resumo

Os mecanismos fisiopatológicos da miocardiopatia periparto ainda não são totalmente definidos, apesar de haver forte associação com vários fatores já conhecidos, incluindo a pré-eclâmpsia. O tratamento segue as mesmas recomendações para a insuficiência cardíaca com disfunção sistólica. Estudos clínicos e experimentais recentes sugerem que os produtos de degradação da prolactina podem induzir a miocardiopatia. A supressão farmacológica da produção de prolactina por agonista do receptor D2 da dopamina, bromocriptina ou cabergolina, vem demonstrando resultados satisfatórios na resposta terapêutica do tratamento. Apresentamos o relato de uma primigesta, adolescente, com miocardiopatia periparto que evoluiu para a normalização da função ventricular esquerda após a administração da cabergolina, utilizada como adjuvante na terapêutica da disfunção cardíaca. Subsequentemente, apesar do intervalo entre as gestações ser considerado curto, apresentou evolução satisfatória em uma nova gestação sem qualquer alteração cardíaca durante todo o período gestacional ou puerpério. Os agonistas dopaminérgicos, drogas de uso oral e de preço acessível para a maioria dos centros terciários, em particular em países subdesenvolvidos, não podem ser esquecidos frente a casos de miocardiopatia periparto.

Keywords

peripartum cardiomyopathy - congestive heart failure - dopamine agonists - pregnancy outcome

Palavras-chave

miocardiopatia periparto - falência cardíaca congestiva - agonistas dopaminérgicos - resultado da gravidez
 

  • References

  • 1 Sliwa K, Hilfiker-Kleiner D, Petrie MC , et al; Heart Failure Association of the European Society of Cardiology Working Group on Peripartum Cardiomyopathy. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur J Heart Fail 2010; 12 (8) 767-778
    CrossrefPubMedGoogle Scholar
  • 2 Hilfiker-Kleiner D, Sliwa K. Pathophysiology and epidemiology of peripartum cardiomyopathy. Nat Rev Cardiol 2014; 11 (6) 364-370
    CrossrefPubMedGoogle Scholar
  • 3 Fett JD, Carraway RD, Dowell DL, King ME, Pierre R. Peripartum cardiomyopathy in the Hospital Albert Schweitzer District of Haiti. Am J Obstet Gynecol 2002; 186 (5) 1005-1010
    CrossrefPubMedGoogle Scholar
  • 4 Elkayam U. Clinical characteristics of peripartum cardiomyopathy in the United States: diagnosis, prognosis, and management. J Am Coll Cardiol 2011; 58 (7) 659-670
    CrossrefPubMedGoogle Scholar
  • 5 McNamara DM, Elkayam U, Alharethi R , et al; IPAC Investigators. Clinical outcomes for peripartum cardiomyopathy in North America: results of the IPAC Study (Investigations of Pregnancy-Associated Cardiomyopathy). J Am Coll Cardiol 2015; 66 (8) 905-914
    CrossrefPubMedGoogle Scholar
  • 6 Gentry MB, Dias JK, Luis A, Patel R, Thornton J, Reed GL. African-American women have a higher risk for developing peripartum cardiomyopathy. J Am Coll Cardiol 2010; 55 (7) 654-659
    CrossrefPubMedGoogle Scholar
  • 7 Goland S, Modi K, Hatamizadeh P, Elkayam U. Differences in clinical profile of African-American women with peripartum cardiomyopathy in the United States. J Card Fail 2013; 19 (4) 214-218
    CrossrefPubMedGoogle Scholar
  • 8 Pearson GD, Veille JC, Rahimtoola S , et al. Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review. JAMA 2000; 283 (9) 1183-1188
    CrossrefPubMedGoogle Scholar
  • 9 Bello N, Rendon IS, Arany Z. The relationship between pre-eclampsia and peripartum cardiomyopathy: a systematic review and meta-analysis. J Am Coll Cardiol 2013; 62 (18) 1715-1723
    CrossrefPubMedGoogle Scholar
  • 10 Johnson-Coyle L, Jensen L, Sobey A ; American College of Cardiology Foundation; American Heart Association. Peripartum cardiomyopathy: review and practice guidelines. Am J Crit Care 2012; 21 (2) 89-98
    CrossrefPubMedGoogle Scholar
  • 11 Blauwet LA, Cooper LT. Diagnosis and management of peripartum cardiomyopathy. Heart 2011; 97 (23) 1970-1981
    CrossrefPubMedGoogle Scholar
  • 12 Sliwa K, Fett J, Elkayam U. Peripartum cardiomyopathy. Lancet 2006; 368 (9536) 687-693
    CrossrefPubMedGoogle Scholar
  • 13 Ramaraj R, Sorrell VL. Peripartum cardiomyopathy: Causes, diagnosis, and treatment. Cleve Clin J Med 2009; 76 (5) 289-296
    CrossrefPubMedGoogle Scholar
  • 14 Rasmusson K, Brunisholz K, Budge D , et al. Peripartum cardiomyopathy: post-transplant outcomes from the United Network for Organ Sharing Database. J Heart Lung Transplant 2012; 31 (2) 180-186
    CrossrefPubMedGoogle Scholar
  • 15 Biteker M, Kayatas K, Duman D, Turkmen M, Bozkurt B. Peripartum cardiomyopathy: current state of knowledge, new developments and future directions. Curr Cardiol Rev 2014; 10 (4) 317-326
    CrossrefPubMedGoogle Scholar
  • 16 Hilfiker-Kleiner D, Sliwa K, Drexler H. Peripartum cardiomyopathy: recent insights in its pathophysiology. Trends Cardiovasc Med 2008; 18 (5) 173-179
    CrossrefPubMedGoogle Scholar
  • 17 Yamac H, Bultmann I, Sliwa K, Hilfiker-Kleiner D. Prolactin: a new therapeutic target in peripartum cardiomyopathy. Heart 2010; 96 (17) 1352-1357
    CrossrefPubMedGoogle Scholar
  • 18 Gonzalez C, Corbacho AM, Eiserich JP , et al. 16K-prolactin inhibits activation of endothelial nitric oxide synthase, intracellular calcium mobilization, and endothelium-dependent vasorelaxation. Endocrinology 2004; 145 (12) 5714-5722
    CrossrefPubMedGoogle Scholar
  • 19 Hilfiker-Kleiner D, Kaminski K, Podewski E , et al. A cathepsin D-cleaved 16 kDa form of prolactin mediates postpartum cardiomyopathy. Cell 2007; 128 (3) 589-600
    CrossrefPubMedGoogle Scholar
  • 20 Patten IS, Rana S, Shahul S , et al. Cardiac angiogenic imbalance leads to peripartum cardiomyopathy. Nature 2012; 485 (7398) 333-338
    CrossrefPubMedGoogle Scholar
  • 21 Jahns BG, Stein W, Hilfiker-Kleiner D, Pieske B, Emons G. Peripartum cardiomyopathy—a new treatment option by inhibition of prolactin secretion. Am J Obstet Gynecol 2008; 199 (4) e5-e6
    PubMedGoogle Scholar
  • 22 Sliwa K, Blauwet L, Tibazarwa K , et al. Evaluation of bromocriptine in the treatment of acute severe peripartum cardiomyopathy: a proof-of-concept pilot study. Circulation 2010; 121 (13) 1465-1473
    CrossrefPubMedGoogle Scholar
  • 23 de Jong JS, Rietveld K, van Lochem LT, Bouma BJ. Rapid left ventricular recovery after cabergoline treatment in a patient with peripartum cardiomyopathy. Eur J Heart Fail 2009; 11 (2) 220-222
    CrossrefPubMedGoogle Scholar
  • 24 Haghikia A, Podewski E, Libhaber E , et al. Phenotyping and outcome on contemporary management in a German cohort of patients with peripartum cardiomyopathy. Basic Res Cardiol 2013; 108 (4) 366
    CrossrefPubMedGoogle Scholar