For women presenting with severe LV dysfunction > 6 months following first presentation despite optimal medical therapy, implantation of an ICD as well as cardiac resynchronization therapy (CRT) are recommended according to current ESC guidelines.54 Although in non‐ischaemic cardiomyopathy the necessity of ICD has been questioned in older patients,82 young patients with severe LV dysfunction despite optimal medical therapy may still derive benefit from ICD implantation.83 Subcutaneous ICDs represent an alternative to transvenous systems, although they neither provide anti‐tachycardia pacing nor post‐shock pacing, but can be more easily extracted if cardiac function recovers. Green: may be used, use with caution; yellow: use with extreme caution; red: should be avoided/contraindicated. and you may need to create a new Wiley Online Library account. Normal growth percentiles and no adverse outcome for infants were observed in a collective of PPCM patients in South Africa where breastfeeding was terminated.71 However, breastfeeding is tolerated by many women with PPCM with respect to their heart failure status. The book’s focal point is less the running of a gallery, however, and more the question of how someone with a severe visual handicap can assert themselves in life and in a society whose orientation is strongly visual. Long‐term follow‐up in peripartum cardiomyopathy patients with contemporary treatment: low mortality, high cardiac recovery, but significant cardiovascular co‐morbidities. Mortality was 17% in PPCM compared to 0% among HHFP. AIDS, acquired immunodeficiency syndrome; CRP, C‐reactive protein; DCM, dilated cardiomyopathy; ECG, electrocardiogram; HOCM, hypertrophic obstructive cardiomyopathy; HF, heart failure; HIV, human immunodeficiency virus; LE, late enhancement; LV, left ventricular; LVEF, left ventricular ejection fraction; LVOTO, left ventricular outflow tract obstruction; MRI, magnetic resonance imaging; PPCM, peripartum cardiomyopathy; RV, right ventricular; VQ, ventilation–perfusion. in genes like titin, beta‐myosin heavy chain, myosin‐binding protein C (MYBPC3), lamin A/C or sodium voltage‐gated channel alpha subunit 5 (SCN5A).17, 19, 35, 36 One theory is that in gene‐positive, phenotype‐negative women without clinical symptoms prior to pregnancy, the physiological stress of pregnancy and delivery may unmask concealed DCM.37 Further investigation is needed regarding mutations or polymorphisms in genes regulating metabolism, oxidative stress response, angiogenesis and the immune system as well as the higher frequency of PPCM in women of African ancestry.10, 13, 27, 38 Genetic testing may be considered in PPCM, in particular in those patients with a positive familial history.

The ongoing international PPCM registry in the EURObservational Research Programme (EORP) has recruited over 750 patients and will be the largest dataset to provide important novel information on PPCM.2, 3 It is unclear in what percentage PPCM persists to chronic, stable heart failure as patients with non‐specific symptoms around pregnancy may remain undiagnosed and are only identified months or years later. Although one study demonstrated plasma BNP levels > 1860 pg/mL as an independent factor for persistent LV dysfunction, prognostic properties of natriuretic peptides remain uncertain.47, 48 Serum troponin concentrations measured at baseline may predict persistent LV dysfunction after 6 months.49 More specific biomarkers would be helpful to allow a faster and more reliable diagnosis of PPCM, but these are yet to be adequately defined. Timely diagnosis and treatment are crucial. If bromocriptine treatment is considered (class IIb recommendation), different regimens are recommended according to disease severity. After stabilization, magnetic resonance imaging may provide a more accurate evaluation of cardiac structure and function, and can sometimes be helpful if there is high suspicion for another diagnosis such as arrhythmogenic right ventricular cardiomyopathy and myocarditis. Table 2 summarizes the diagnostic tests that are recommended for the diagnosis of PPCM at initial diagnosis and at follow‐up visits. 4. To prevent abrupt pressure or volume changes, epidural anaesthesia might be the method of choice but should be carefully titrated, guided by an expert anaesthetic team.4, 56, 57 If MCS may become necessary, the patient should be delivered by appropriate teams in hospitals capable of providing such care. We learn little about the role played by Kirsa Geiser, König’s former partner and long-standing gallery director, who left in the spring of 2011. Women who present with PPCM during pregnancy require joint cardiac and obstetric care.4, 57 Possible adverse effects on the foetus must be considered when prescribing drugs. The artist (currently representing Germany in Venice) opened an elaborate sound installation at König Galerie in 2003 with the wonderful title ‘The Illnesses of the Eagle Owl and their Significance for its Repatriation in the Federal Republic of Germany’. BOARD scheme for the therapy of patients with acute peripartum cardiomyopathy (PPCM). In peripartum cardiomyopathy plasminogen activator inhibitor-1 is a potential new biomarker with controversial roles.

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