PPCM Pregnancy-specific Management — EECC MCQ
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Correct answer: B — ACEi/ARB/ARNI are contraindicated during pregnancy (teratogenic) — use hydralazine + nitrate for afterload reduction; bromocriptine may be considered to reduce prolactin-mediated myocardial damage; delivery timing must balance maternal cardiac and fetal maturity considerations
PPCM management per the 2025 ESC CVD in Pregnancy and 2023 ESC Cardiomyopathy Guidelines requires pregnancy-specific modifications: (1) CONTRAINDICATED in pregnancy: ACEi, ARB, ARNI (teratogenic), MRA (anti-androgenic — feminisation of male fetus), ivabradine; (2) SAFE: beta-blockers (metoprolol, bisoprolol), hydralazine + isosorbide dinitrate (afterload/preload reduction substitute for RAAS inhibitors), diuretics cautiously (avoid volume depletion → uteroplacental hypoperfusion); (3) PPCM-SPECIFIC: bromocriptine (dopamine agonist — inhibits prolactin, which may reduce 16-kDa prolactin fragment-mediated myocardial damage; Class IIb, evidence from African studies); requires anticoagulation if used (prothrombotic); (4) DELIVERY: timing is a Heart Team/MDT decision — severe LVEF depression (<30%) or haemodynamic instability may warrant early delivery; (5) POST-PARTUM: switch to standard GDMT (ACEi/ARNI, MRA) immediately; LVEF recovery occurs in ~50-70% within 6-12 months.
Reference: ESC (2025): CVD in Pregnancy; ESC (2023): Cardiomyopathies