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    Cardiac Disease in Pregnancy

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    viharadewi
    Cardiac disease in pregnancy can pose risks to both mother and baby. The cardiovascular system experiences changes during pregnancy like increased blood volume and decreased vascular resistance. Women with conditions like severe mitral stenosis, pulmonary hypertension, or left ventricular dysfunction are at high risk and advised to avoid pregnancy. Those with mild-moderate disease require close monitoring. Symptoms like dyspnea or murmurs during pregnancy warrant evaluation. Treatment involves managing preexisting conditions and hypertensive disorders, with care taken on drug safety.

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    Cardiac Disease in Pregnancy

    Uploaded by

    viharadewi
    135 views28 pages
    Cardiac disease in pregnancy can pose risks to both mother and baby. The cardiovascular system experiences changes during pregnancy like increased blood volume and decreased vascular resistance. Women with conditions like severe mitral stenosis, pulmonary hypertension, or left ventricular dysfunction are at high risk and advised to avoid pregnancy. Those with mild-moderate disease require close monitoring. Symptoms like dyspnea or murmurs during pregnancy warrant evaluation. Treatment involves managing preexisting conditions and hypertensive disorders, with care taken on drug safety.

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    Cardiac disease in pregnancy can pose risks to both mother and baby. The cardiovascular system experiences changes during pregnancy like increased blood volume and decreased vascular resistance. Women with conditions like severe mitral stenosis, pulmonary hypertension, or left ventricular dysfunction are at high risk and advised to avoid pregnancy. Those with mild-moderate disease require close monitoring. Symptoms like dyspnea or murmurs during pregnancy warrant evaluation. Treatment involves managing preexisting conditions and hypertensive disorders, with care taken on drug safety.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    135 views28 pages

    Cardiac Disease in Pregnancy

    Uploaded by

    viharadewi
    Cardiac disease in pregnancy can pose risks to both mother and baby. The cardiovascular system experiences changes during pregnancy like increased blood volume and decreased vascular resistance. Women with conditions like severe mitral stenosis, pulmonary hypertension, or left ventricular dysfunction are at high risk and advised to avoid pregnancy. Those with mild-moderate disease require close monitoring. Symptoms like dyspnea or murmurs during pregnancy warrant evaluation. Treatment involves managing preexisting conditions and hypertensive disorders, with care taken on drug safety.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
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    At a glance
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    The document discusses how pregnancy places additional strain on the cardiovascular system and outlines some common heart conditions seen in pregnant women as well as their management and treatment. It also covers hypertensive disorders that can occur during pregnancy.

    During pregnancy, the body undergoes several hemodynamic modifications to support the developing fetus, including increased blood volume, decreased systemic vascular resistance and blood pressure, increased resting heart rate, and increased cardiac output.

    Some common cardiovascular diseases seen in pregnancy mentioned in the document include rheumatic heart disease, prosthetic heart valves, hypertension, congenital heart diseases, peripartum cardiomyopathy, Marfan syndrome, and arrhythmias.

    Cardiac Disease in Pregnancy

    Vihara Dewi Mahendra,S.ked


    Nasratul Ilmi ,S.ked

    Introduction
    Pregnancy, labor and delivery are
    associated with burdens on the
    cardiovascular system
    The outcome of pregnancy is related to
    functional class and underlying heart
    disease

    Hemodynamic Modifications during


    Pregnancy
    Blood volume starts to rise at 5th week
    Systemic vascular resistance and blood
    pressure are decreased
    Resting heart rate increases by 10-20
    beats/min
    Cardiac output increases by 30-50%

    High Risk Pregnancy


    Advise avoidance of pregnancy
    Mitral stenosis with functional class II-IV
    Mitral and aortic regurgitation with functional class III,
    IV
    Severe pulmonary hypertension
    Left ventricular dysfunction
    Marfans syndrome with dilated aortic root
    (> 40 mm)
    Cyanotic heart disease
    Severe obstructive lesion (aortic stenosis, pulmonary
    stenosis)

    High Risk Pregnancy


    Close follow up required
    Prosthetic valve
    Mild to moderate valvular heart disease
    Marfans syndrome without aortic root
    dilatation

    Suspicious Symptoms and Signs of


    Cardiac Disease in Pregnancy

    Progressive dyspnea
    Syncope
    Chest pain
    Cyanosis
    Left parasternal heave
    A grade III/VI or greater systolic murmur
    Any diastolic murmurs
    S4 gallop
    Fixed split of S2
    Opening snap

    Cardiovascular Disease
    in Pregnancy
    Valvular Heart disease
    Rheumatic heart disease
    Prosthetic heart valves
    Hypertension
    Congenital heart disease
    Peripartum cardiomyopathy
    Marfan syndrome and aortic regurgitation
    Arrhythmias

    Hypertension in Pregnancy
    Complicates 6-8 % of all pregnancies
    Complications
    Cerebral hemorrhage
    Hepatic failure
    Acute renal failure
    Abrutio placenta
    Pregnancy outcomes relate with underlying
    causes of HT

    Cardiovascular Drugs
    in Pregnancy
    Drug

    Use in pregnancy

    Digoxin
    Beta-blocker
    Nifedipine
    Hydralazine
    Nitrate
    IHD
    Diuretics
    ACEI
    Amiodarone

    HF, arrhythmia
    HT,MS, IHD
    HT
    HT, HF

    HF,HT
    HT, HF
    Arrhythmias

    Safety

    Safe
    Safe
    Safe
    Safe
    Limited data
    +/Unsafe
    Unsafe

    Pharmacological Treatment

    Methydopa: first line agent; 750 mg-4 g


    Betablocker
    Calcium channel blocker
    Hydralazine
    Diuretics:
    Contraindicated in preeclampsia
    May reduce uteroplacental flow

    ACEI and ARB blocker: renal agenesis

    Cardiovascular Evaluation
    in Pregnancy
    History
    Physical examination
    Investigations
    ECG
    Echocardiography

    Hypertensive Disorder
    Classification and definition
    Chronic HT: HT prior or before 20 wks of gestation
    Preeclampsia-eclampsia: proteinuria with new HTafter
    20 wks of pregnancy
    Pre-eclampsia superimposed on chronic HT: increased
    BP (30/15); change in proteinuria or target organ
    damage
    Gestational HT: new HT after 20 wks of pregnancy
    without proteinuria
    Transient HT: elevated HT during or after pregnancy
    without sings of preeclampsia

    Mitral Stenosis
    Most common valve disease in pregnancy
    Valve area < 1.5 cm2 increases risk of
    Pulmonary edema
    Heart failure
    Arrhythmias
    Intrauterine growth retardation
    Closed follow up is necessary
    Doppler echo at 3 and 5 month and
    monthly thereafter

    Diagnostic Assessment
    Echocardiography

    Confirm diagnosis
    Determine the severity of stenosis
    Pulmonary artery pressure and RV function
    Mitral valve score to determine the success of
    percutaneous mitral balloon valvuloplasty

    Medical Management
    Most pregnant woman with mitral stenosis
    can be managed medically
    Limit activity
    Restrict salt and fluid
    Diuretic if needed

    Medical Management
    Digoxin is useful in atrial fibrillation
    Rheumatic prophylaxis
    Penicillin V 250 mg X 2
    Benzathine Penicillin IM q 3 weeks
    Betablocker

    Beta-blocker in Pregnancy
    Beta-1 selective agents ;metoprolol and
    atenolol limits the risk interaction with
    uterine contraction
    Cross placenta and excrete in breast milk
    No serious adverse effects on neonates
    Fetal bradycardia and hypoglycemia have
    been reported

    Percutaneous Balloon
    Mitral Valvuloplasty (PBMV)
    Should be considered after failure of
    aggressive medical treatment
    Radiation exposure and technical
    difficulties are major limitations
    Transesophageal echocardiography
    guidance may decrease the fluoroscopy time
    and maternal complications

    Surgical Intervention
    Indicated in patients who failed medical
    treatment
    Should be performed between 24-28 weeks
    gestation
    Maternal mortality rate 1.5-5%
    Fetal mortality rate 20-30 % in open heart
    surgery
    Closed mitral valvotomy is preferable
    safe for mother
    fetal mortality of 2-12%

    ATRIAL FIBRILLATION

    Digoxin 0.25 to 0.5 mg IV, then 0.25 mg IV 4 to 6 hrly to


    maximum of 1 mg
    Propanolol 1 mg IV over 2 minutes, may repeat every 5 min
    to maximum of 5 mg, maintenance 1 to 3 mg IV 4 hrly

    Calcium channel blocker


    Diltiazem 15 to 20 mg IV over 2 min, may repeat in 15 min,
    maintenance 5 to 15 mg per hr by continuous IV infusion
    Verapamil 5 to 10 mg IV over 2 min, may repeat in 30 min

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