A 32-year-old woman develops sudden onset of chest pain, dyspnea and pulmonary edema 2 weeks after delivery of her first child. Echo shows EF 28%, dilated left ventricle, no regional wall motion abnormality. Coronary angiography is normal. Diagnosis is peripartum cardiomyopathy (PPCM). The management includes standard HFrEF therapy PLUS which specific agent that targets the proposed pathogenic mechanism?
- A Magnesium sulfate infusion
- B Bromocriptine (dopamine agonist to inhibit prolactin secretion) ✓
- C Progesterone supplementation
- D Pentoxifylline
Correct answer: B. Bromocriptine (dopamine agonist to inhibit prolactin secretion)
Explanation
The proposed pathogenic mechanism of PPCM involves cathepsin D-mediated cleavage of prolactin into a 16-kDa antiangiogenic and pro-apoptotic fragment that damages cardiomyocytes. Bromocriptine, by suppressing prolactin secretion, has shown improvement in recovery of EF in the BOARD trial (Hilfiker-Kleiner). Current ESC guidelines recommend considering bromocriptine in PPCM. Breastfeeding must be discontinued if bromocriptine is used.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.