In peripartum cardiomyopathy (PPCM), a biomarker pathway involving prolactin cleavage has been implicated in pathogenesis. Based on this mechanism, which adjunct therapy has been proposed and studied in PPCM?

• A Cabergoline to stimulate prolactin release from anterior pituitary
• B Oxytocin analogue to improve cardiac contractility
• C Estrogen supplementation to counteract prolactin effects
• D Bromocriptine (dopamine agonist) to inhibit prolactin secretion ✓

Explanation

In PPCM, cathepsin D cleaves full-length prolactin into a 16-kDa antiangiogenic fragment that causes oxidative stress, endothelial apoptosis, and cardiomyocyte dysfunction. Bromocriptine, a dopamine D2 agonist, inhibits prolactin secretion from the anterior pituitary, thus preventing generation of the cardiotoxic prolactin fragment. The German PPCM trial (IPAC registry) and the BRoMocriptine In CardiOmyopathy (BRICO) pilot trial showed promising results with bromocriptine 2.5 mg daily for 4–8 weeks improving EF recovery. Current ESC guidelines (2018) give bromocriptine a Class IIb recommendation in PPCM, given as an adjunct to standard heart failure therapy. Breastfeeding is generally discontinued if bromocriptine is used.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.