Cardiovascular disease in pregnancy Dr Z Allameh MD

Cardiovascular disease in pregnancy Dr. Z Allameh MD

A bout 1% heart disease ¬Rheumatic heart disease ¬Congenital heart disease ¬Hypertensive heart disease

Physiological considerations with heart disease in pregnancy

Hemodynamic changes in N. l P ¬Cardiac output ¬Heart rate ¬Left ventricular stroke work index ¬Vascular resistance systemic ¬Pulmonary ¬Mean arterial pressure ¬Colloid osmotic pressure +43 +17 -21 -34 +4 -14

Diagnosis of heart disease ¬Electro. Cardio. Graphy ¬Chest X-RAY ¬Echocardiography

Clinical indicators of heart disease during pregnancy ¬ Symptoms Progressive dyspnea or orthopnea Noctural cough , Hemoptysis , Syncope , Chest pain ¬ Clinical findings Cyanosis , clubbing of fingers Persistent neck vein distention Systolic murmur grade 3/6 or greater Diastolic murmur , Cardiomegaly Persistent arrhythmia Persistent split –second sound Criteria for pulmonary hypertension

Clinical classification ¬Class III ¬Class IV

Preconceptional counseling

General management ¬Class I , II labor and delivery Group 1_ Minimal Risk Atrial septal defect Ventricular septal defect Patent ductus arteriosus Pulmonic or tricuspid disease Fallot tetralogy , corrected Bioprosthetic valve Mitral stenosis , NYHA

Group 2_ Moderate Risk 5 -15% 2 A: ¬ Mitral stenosis , NYHA classes III , IV ¬ Aortic stenosis ¬ Aortic coarctation without valvar involvement ¬ Fallot tetralogy , uncorrected ¬ Previous myocardial infarction ¬ Marfan syndrome , normal aorta 2 B: Mitral stenosis with atrial fibrilation Artificial valve

Group 3 - Major Risk 25 -50% ¬Pulmonary hypertension ¬Aortic coarctation with valvar involvement ¬Marfan syndrome with aortic involvement

Intrapartum heart failure

Management of class III , IV