As such, the slow infusion provides a safer control of the diuretic response since the magnitude of the diuresis varies by patient. It is hoped that the approval of tolvaptan in May 2009 will ease the treatment of euvolemic and hypervolemic hyponatremia since tolvaptan can be administered orally, eliminating the possibility of infusion site reactions that come with the current method of central line administration.19 Acknowledgments We are indebted to Wadi Suki, M.D., for his editorial assistance, and Michael
Sirimaturos, Pharm.D., for his guidance in gathering data. Funding Statement Inhibitors,research,lifescience,medical Funding/Support: The authors have no funding disclosures. Footnotes Conflict of Interest Disclosure: The authors have completed and submitted the Methodist DeBakey Oligomycin A Sigma Cardiovascular Journal Conflict of Interest Statement Inhibitors,research,lifescience,medical and none were reported.
Introduction Peripartum cardiomyopathy (PPCM) Inhibitors,research,lifescience,medical is a rare and potentially fatal disease.1 Although phenotypically it resembles nonischemic dilated cardiomyopathy
(DCM), the clinical course is highly variable and differs significantly from other forms of cardiomyopathies.1 Its clinical course is highly unpredictable — it may vary from rapid progression to end-stage heart failure within a few Inhibitors,research,lifescience,medical days2 to spontaneous resolution and complete recovery in a few weeks to months.3-5 Definition
and Incidence The initial definition of PPCM was established according to the four criteria adapted from the study by Demakis Inhibitors,research,lifescience,medical et al.1 and recommended by a workshop convened in 1997 by the National Heart, Lung and Blood Institute and the Office of Rare Diseases of the National Institutes of Health.2 The four criteria are as follows: (1) development of cardiac failure in the last month of pregnancy or within 5 months of Entinostat delivery; (2) absence of an identifiable cause for the cardiac failure other than pregnancy; (3) absence of recognizable heart disease before the last month of pregnancy; and (4) left ventricular systolic dysfunction (LVSD) with left ventricular ejection fraction (LVEF) <45% by echocardiography, fractional shortening <30%, or both.2 PPCM remains a diagnosis of exclusion; all other causes of DCM with heart failure must be systematically excluded before establishing the diagnosis of PPCM.6 Since 1997, the definition of PPCM has varied slightly. The European Society of Cardiology on the classification of cardiomyopathies has defined it as “a non-familial, non-genetic form of dilated cardiomyopathy associated with pregnancy.