In the management of peripartum cardiomyopathy, which therapies are commonly considered to optimize cardiac output?

• A. Diuretics, antihypertensives, and beta blockers
• B. ACE inhibitors only
• C. Calcium channel blockers only
• D. No medications

Answer: (A)

In peripartum cardiomyopathy the aim is to improve the heart’s forward pumping ability while unloading excess fluid. Diuretics reduce preload by removing excess volume, which helps relieve pulmonary and systemic congestion and makes it easier for the weakened heart to deliver blood forward. Antihypertensives help decrease afterload, so the heart doesn’t have to work as hard to push blood through the circulation, which can improve stroke volume and overall cardiac output. Beta blockers, added once the patient is stable, slow the heart rate and reduce myocardial oxygen demand, which supports better filling and can help limit adverse remodeling over time. Calcium channel blockers are not ideal here because they can depress contractility and may worsen heart failure in reduced ejection fraction. Not using any medications would leave the heart failure symptoms uncontrolled, and relying on only one medication class misses the combination that best supports cardiac output.