Peripartum cardiomyopathy (PPCM) is a diagnosis of exclusion. According to the ESC 2019 position statement, which drug used for heart failure is ABSOLUTELY CONTRAINDICATED in PPCM during active breastfeeding?

• A Hydralazine — vasodilator that causes reflex tachycardia
• B Bromocriptine — used to suppress prolactin and accelerate PPCM recovery
• C ACE inhibitors and ARBs — teratogenic but specifically harmful during breastfeeding ✓
• D Beta-blockers (carvedilol) — suppresses lactation via dopaminergic effects

Explanation

ACE inhibitors (enalapril, ramipril) and ARBs are first-line for HFrEF but are absolutely contraindicated in breastfeeding due to neonatal hypotension, renal failure, and electrolyte disturbances from drug excretion in breast milk. In PPCM, captopril and enalapril are safe with breastfeeding per some guidelines, but ARBs are not. Bromocriptine (dopamine agonist) suppresses prolactin, reduces PPCM severity, and is recommended by ESC 2019 for PPCM — it requires contraception but is not contraindicated in PPCM itself. Beta-blockers (carvedilol) are used cautiously in PPCM and are compatible with breastfeeding.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.