PPCM Definition Female-only — EECC MCQ

Correct answer: D — No — peripartum cardiomyopathy (PPCM) is by definition restricted to women occurring in the last month of pregnancy or within 5 months post-partum; male patients presenting with new-onset DCM should be investigated for other causes including genetic cardiomyopathy, myocarditis, toxins, or metabolic disease

PPCM is defined by the ESC as: new-onset HF with LVEF <45% occurring in the last month of pregnancy or within 5 months post-partum, in the absence of another identifiable cause. It is by definition a FEMALE-ONLY condition related to pregnancy-specific pathophysiology: (1) 16-kDa prolactin fragment (cleaved from prolactin by cathepsin D under oxidative stress) causes endothelial damage, cardiomyocyte apoptosis, and impaired angiogenesis; (2) sFlt-1/PlGF imbalance (anti-angiogenic factors from the placenta). A young man with new-onset DCM requires: (1) comprehensive genetic testing (TTN, LMNA, DSP, FLNC, MYH7, TNNT2 — ~30-40% of 'idiopathic' DCM has a genetic cause); (2) CMR (to exclude myocarditis — subepicardial LGE pattern); (3) toxin screening (alcohol, cocaine, anabolic steroids); (4) metabolic workup (thyroid, iron, Fabry); (5) viral serology if myocarditis suspected. Genetic cardiomyopathy in young men is the most common diagnosis.

Reference: ESC (2023): Cardiomyopathies; ESC (2025): CVD in Pregnancy