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heart disease during pregnancy

Etiology: - congenital heart disease - bicuspid aortic valve most common - acquired heart disease Clinical manifestations: - altered hemodynamics of pregnancy may reveal murmurs not previously heard [1] - most murmurs are grade 1-2 mid-systolic murmurs without radiation - systolic murmur grade 1-2 present in 80% of pregnancies - other murmurs not normal - mild dyspnea with exertion - orthopnea, paroxysmal nocturnal dyspnea, cough not normal - palpitations, atrial premature beats, ventricular premature beats - atrial fibrillation, atrial flutter, ventricular tachycardia not normal - no chest pain or chest pressure - 20-30% increase in heart rate - heart rate > 100/min not normal - drop in blood pressure of ~10 mm Hg - symptomatic hyptension is not normal - mild peripheral edema - pulmonary edema is not normal - S3 heart sound - S4 heart sound is not normal Complications: Independent predictors of maternal cardiac complications: 1) left ventricular systolic dysfunction, LVEF < 40% - high risk of fetal & maternal complications - contraindication to pregnancy 2) left heart obstruction* a) mitral valve stenosis, valve area < 2.0 cm2 b) aortic valvular stenosis, valve area < 1.5 cm2 3) poor NYHA functional class (3 or 4) or cyanosis 4) prior cardiac events or arrhythmias * valvular regurgitation tolerated better than valvular stenosis Management: - pregnancy or planned pregnancy in patients with severe mitral stenosis, is an indication for mitral valve surgery regardless of symptoms [2] - mitral valve balloon angioplasty for most patients [2] Notes: - women with severe pulmonary hypertension (systolic pressure 2/3 that of systemic circulation) have maternal mortality of 30-50% [2]

Specific

arrhythmia during pregnancy

General

pregnancy disorder; obstetric disorder; pregnancy complication heart disease (cardiac disease)

References

  1. Journal Watch 21(19):151, 2001 - Siu SC, Sermer M, Colman JM et al Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation 104:515, 2001 PMID: 11479246
  2. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18. American College of Physicians, Philadelphia 2012, 2015, 2018.
  3. Franklin WJ, Gandhi M. Congenital heart disease in pregnancy. Cardiol Clin. 2012 Aug;30(3):383-94 PMID: 22813364