The BOARD Framework: Your Treatment Strategy

Managing Peripartum Cardiomyopathy (PPCM) requires a proactive and structured approach. The goal is to take the “workload” off your heart so the muscle has the best possible chance to heal ^[1][2]. Many specialists use the BOARD framework to organize this treatment ^[3][4].

The BOARD Framework

This acronym represents the five pillars of modern PPCM care:

• B: Bromocriptine
  This medication targets the “bad actor” (16kDa prolactin) mentioned on previous pages. It blocks the pituitary gland from releasing prolactin, stopping the production of the toxic fragments ^[5][6]. While bromocriptine is recommended by some international guidelines (like in Europe) and has been associated with better heart recovery in some studies, it is not universally prescribed and is still being actively studied in clinical trials (such as the REBIRTH trial in the US) ^[7][8]. Your doctor will discuss if this targeted therapy is right for you.
• O: Oral Heart Failure Medications
  These are the “gold standard” drugs used to support the heart. They include:
  • Beta-blockers: To slow the heart rate and lower blood pressure ^[9].
  • ACE Inhibitors / ARBs / Entresto: These relax blood vessels. Note: These are strictly contraindicated (unsafe) during pregnancy. Postpartum, their safety during lactation varies significantly. For example, Entresto is generally unsafe during breastfeeding, whereas certain ACE inhibitors (like enalapril) are considered safe ^[10][9]. Your care team will select specific lactation-safe medications if you choose to breastfeed.
  • MRAs (like Spironolactone): To prevent scarring of the heart muscle ^[11].
• A: Anticoagulants
  PPCM significantly increases your risk of blood clots. Additionally, bromocriptine carries a known, severe risk of strokes and cardiovascular clotting events in postpartum women ^[12][13]. Because of this serious risk, doctors mandate “blood thinners” (like heparin or Lovenox) alongside bromocriptine to prevent life-threatening clots ^[12].
• R: Relaxants (Vasodilators)
  These drugs (like hydralazine) help “relax” the arteries, making it easier for a weak heart to pump blood forward ^[3].
• D: Diuretics
  Commonly called “water pills,” these help your body get rid of excess fluid that builds up in your lungs and legs, making it much easier for you to breathe ^[3].

A Note on Breastfeeding and Bromocriptine

Because bromocriptine works by stopping prolactin, taking it will also stop your breast milk production ^[5][14]. The decision between taking bromocriptine and breastfeeding is highly personal and should be a shared decision-making process with your doctor.

Many women recover fully on standard, breastfeeding-safe heart failure medications without using bromocriptine ^[15][16]. Your care team will weigh your clinical symptoms, the severity of your heart failure, and your personal preferences regarding lactation to find the safest path forward for both you and your baby.

Adapting Treatment

Your treatment plan must be customized based on where you are in your journey:

• If you are still pregnant: Your doctors will avoid ACE inhibitors and MRAs, focusing on baby-safe alternatives like certain beta-blockers and vasodilators ^[9][4].
• If you are postpartum: You can typically start the full range of oral medications. If you decide to breastfeed, your doctor will adjust your oral medications to those that are safest for the infant ^[11][9].

Lifestyle and Home Management

While lifestyle did not cause your PPCM, managing your daily habits helps reduce the workload on your healing heart. Your doctor will likely recommend sodium (salt) restriction and fluid management (limiting how much you drink daily) to prevent excess fluid from backing up into your lungs and legs ^[3].