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Ivabradine Pharmacology — EECC MCQ

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HardHeart FailureIvabradine PharmacologyEECC

A 34-year-old developed peripartum cardiomyopathy after her first pregnancy. Eighteen months later she is asymptomatic on treatment, but CMR and echocardiography repeatedly show an LVEF of 42%. She asks about another pregnancy. What advice is most appropriate?

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Correct answer: A — Avoid a further pregnancy while LV systolic impairment persists

Persistently impaired LV systolic function after peripartum cardiomyopathy confers substantial risks of relapse, severe heart failure and maternal death in another pregnancy, so further pregnancy should be strongly discouraged while LVEF is 42%. Merely switching teratogenic drugs does not remove myocardial risk. Normal contractile reserve on stress echocardiography cannot override persistent dysfunction. Prophylactic ICD implantation prevents selected arrhythmic deaths but not recurrent pump failure, and another six months of unchanged imaging would not establish recovery.

Reference: 2025 ESC Guidelines for cardiovascular disease and pregnancy. https://academic.oup.com/eurheartj/article/46/43/4462/8234487