LEXINGTON, Ky. (Sept. 20, 2024) – After the birth of her little girl, Bella, Marishia Hamilton of Lexington knew something wasn’t right.
Marishia was tired and out of breath. She couldn’t remember feeling that way after the birth of her son Bryson, 12 years ago.
“I’m just getting used to being a new mom,” Marishia said. I hadn’t had a child in 12 years. I thought I had to adjust.”
He followed the doctor, who advised him to get more rest. The second doctor said he needed to be more active.
He said: “I felt defeated. “I don’t know what to do. Do I rest more, or do I work more? How am I supposed to rest with a newborn?”
A month after giving birth, Marishia developed a severe cough. He couldn’t stop coughing, he couldn’t breathe. She gave Bryson baby Bella, afraid he would drop her.
In the emergency department at the University of Kentucky Good Samaritan Hospital, doctors could tell something was very wrong. She was transferred to UK Albert B. Chandler Hospital, where, just days into her week-long stay, she was given a potentially fatal diagnosis: peripartum cardiomyopathy (PPCM). .
“I had never even heard of it,” said Marishia. “Even after I Googled, I still didn’t understand. I didn’t know I had a heart attack.”
Peripartum cardiomyopathy is a rare form of heart failure that occurs late in pregnancy or in the first few months after delivery. The exact cause of PPCM is unknown. There may be a genetic component, although most women who develop PPCM do not have a family history of heart failure.
“Most women will develop it in the latter part of their pregnancy, or in the first few months after giving birth,” said Navin Rajagopalan, MD, a cardiologist at the Gill Heart & Vascular Center of UK HealthCare. “These are women with no history of heart disease in the past, no history of heart disease in the past and no heart disease. Women present with shortness of breath , swelling, fatigue, but all these symptoms can be felt after childbirth. As a result, it can be difficult to diagnose peripartum cardiomyopathy.
After being tested, Marishia realized that her symptoms were normal. He was out of breath and walking downhill. His care team was surprised that he was as active as he was given his condition. But the relief he felt when he finally got answers was short-lived. As a mother of four, she immediately thought of her children.
“I called my father, my boyfriend and my aunt and told them that I have a heart problem,” said Marishia. I was very scared because I can’t leave my babies.
Marishia was taken to Rajagopalan, who made sure she was taking medicines known to help heart patients. He also talked to Marishia about participating in a drug trial that is investigating whether another drug might be beneficial for peripartum cardiomyopathy patients.
The Randomized Evaluation of Bromocriptine In Myocardial Recovery Therapy study, or REBIRTH, is a study led by researchers and physicians at the University of Pittsburgh. Research suggests that a hormone known as prolactin may play a role in the development of PPCM. Prolactin levels are high around the time of childbirth and stimulate milk production (lactation) needed for breastfeeding. Postpartum stress sometimes results in a breakdown of prolactin, producing small proteins in the blood that have a negative effect on blood vessels and the heart. Laboratory methods have shown that blocking the release of this hormone with bromocriptine can prevent the development of peripartum cardiomyopathy.
Marishia was suspicious. He was going to be given a drug or a placebo, so he didn’t see the point. The drug might have made him better, but what if it did nothing, or made his condition worse?
Rajagopalan listened to Marishia’s concerns and assured her that the medicine would not hurt her. As one of UK HealthCare’s leading experts in heart failure, Rajagopalan closely monitored Marishia throughout the trial. After eight weeks on medication, he followed up with Rajagopalan regularly over the course of a year. Marishia and Rajagopalan were both happy to see that her heart function had improved, and she was no longer showing signs of heart failure.
She said: “It has been great to see Marishia improve and be able to lead a normal life. “Because REBIRTH is a blinded study, neither Marishia nor I know whether she received the active drug bromocriptine or a placebo. .But thanks to brave patients like Marishia, we hope to be able to improve our care for women in the future.”
Heart health is determined by ejection fraction – the amount of blood pumped out of the heart with each heartbeat. A normal ejection fraction is 50% or more; Marisha reports that her heart rate is up to 47% and increasing. Now he has the strength to keep up with Bella, who has just started walking.
“I can actually walk a long distance and not be so out of breath,” Marishia said. It’s wonderful because I feel happy, and I feel like I’m coming back to myself. I feel that this will help my children and my family to give me a long time.”
There is currently uncertainty in the medical community if all women with peripartum cardiomyopathy should be started on bromocriptine. Bromocriptine prevents women from being able to breastfeed, so starting the medication requires a shared decision between the patient and their doctor. The REBIRTH trial hopes to provide a definitive answer as to whether bromocriptine has additional benefits for women in addition to standard medical treatment. The University of Kentucky is one of 50 institutions across the country participating in REBIRTH and the only institution in Kentucky. Learn more about the study here.
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