BACKGROUND

Normal pregnancy physiology can severely exacerbate

cardiac disease during pregnancy.

Normal pregnancy
physiology

Increased Decreased
intravascular Hypercoagulability systemic vascular
volume resistance
 Pulmonary
hypertension

High
maternal
mortality
risk.
Severe Marfan
cardiomiopathy syndrome
BACKGROUND
WOMEN WITH CARDIAC DISEASE IN PREGNANCY ARE AT HIGHER RISK FOR:

Cardiovascular Neonatal
Maternal death
complication complication
BACKGROUND

Trial of intervention
specifics for
cardiac disease in
pregnancy.
 Fatigue

Limitation of
Cyanosis physical
ability

Dyspnea on Symptomps
Palpitations
exertion and signs

Chest pain Tachycardia

Shortness of
breath
EPIDEMIOLOGY
Complicate 1-4% of pregnancies.

10-25% of Genetics:
maternal
mortality. Maternal congenital heart defect>>>increased
risk for the fetus to get congenital heart defect
ETIOLOGY

PRINCIPAL PHYSIOLOGIC CHANGES OF PREGNANCY CAN COMPLICATE CARDIAC DISEASE DURING

PREGNANCY
 Decreased
systemic
vascular
resistance

Increase in
cardiac Incerease in
output intravascula
during r volume
parturition
Etiology

Postpartum
increase in
Hypercoagu
intravascula
lability
r volume
load
CLASSIFICATION
 Complication

Maternal Neonatal
mortality complication
 Decreased systemic

Maternal mortality
vascular resistance

Incerease in intravascular
volume

Postpartum increase in
intravascular volume load

Hypercoagulability

Increase in cardiac output

during parturition
Neonatal complication
Preterm birth

Misscariage

Growth
restriction
 Preconception
counseling

Management
Prenatal
General
care/antepartum
management
testing
GENERAL MANAGEMENT
Antepartum activity restriction

Treat coexisting medical conditions

Collaborative care by multiple specialists

Labour in lateral decubistus position

GENERAL MANAGEMENT
Epidural anesthesia

Oxygen, particularly during labour and delivery

Bacterial endocarditis prophylaxis

Cesarian delivery (reserved for obstetrical indications only)

GENERAL MANAGEMENT
Invasive haemodinamic monitoring

Avoiding hypotension during labour and delivery

Postpartum contraceptive management

PALPITATIONS

WORKUP:
THYROID FUNCTION
RULING OUT: DRUGS, ALCOHOL, CAFFEINE, SMOKING
ECG
USUALLY BENIGN
COARTATION OF AORTA

SURGICALLY CORRECTED>>>GOOD MATERNAL OUTCOME

CARDIOVASCULAR MRI>>>RISK STRATIFICATION
TETRALOGY OF FALLOUT
CONSISTS OF:
VSD
PULMONARY STENOSIS
RIGHT VENTRICLE HYPERTROPHY
OVERRIDING AORTA
CORRECTED LESSION DO WELL
UNCORRECTED LESSION RELATES TO HIGHER MATERNAL MORTALITY
MITRAL STENOSIS

SIGNIFICANT STENOSIS>>>LIMITED LEFT VENTRICULAR FILLING>>>FIXED CARDIAC OUTPUT>>>FAIL IN

VOLUME SHIFT ACCOMODATION>>>PULMONARY EDEMA
TREATMENT: PERCUTANNEOUS BALLON VALVULOPLASTY
AORTIC STENOSIS

ISSUE: FIXED AND LIMITED CARDIAC OUTPUT

HYPOTENSION SHOULD BE AVOIDED
MITRAL-AORTIC INSUFFICIENCY

AVOID
ARRHYTMIA
BRADYCARDIA
MYOCARDIAL DEPPRESSANT
MARFAN SYNDROME

AN AUTOSOMAL DOMINANT GENERALIZED CONNECTIVE TISSUE DISORDER

RISK: AORTIC ANEURISM>>>RUTURE AND DISSECTION
AVOID HYPERTENSION
CONSIDER BETA-BLOCKER THERAPY
HYPERTROPIC CARDIOMYOPATHY
RESULTS IN LEFT VENTRICULAR CARDIOMYOPATHY
LEADING TO LEFT VENTRICULAR OBSTRUCTION
AVOID:
TACHYCARDIA
HYPOVOLEMIA
HYPOTENSION
CORONARY ARTERY DISEASE
RISK FACTOR: TREATMENT:
DIABETES NITRATE, CALCIUM CHANNEL BLOCKERS, BETA
OBESITY BLOCKERS
HYPERCHOLESTEROLEMIA COUNCELING REGARDING RISKS
SMOKING PERCUTANEOUS CORONARY INTERVENTION
HYPERTENSION STENT

STRESS ANGIOPLASTY
THROMBOLYTIC THERAPHY