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{{Pregnancy and heart disease}}
{{Pregnancy and heart disease}}


{{CMG}}; '''Associate Editor In Chief:'''  {{AC}}
{{CMG}}; {{AOEIC}} {{AC}}
 


==Overview==
==Overview==
Women with acquired or congenital heart disease have a higher risk of cardiac complications during pregnancy than the general population.  In general, a full evaluation including history, physical examination, echocardiogram, and electrocardiogram should be considered for these patients.  Further risk stratification and monitoring are determined by a number of factors, including the prior cardiac events, the presence of heart failure, valvular disease, and systolic or diastolic dysfunction.   
Women with acquired or [[congenital heart disease]] have a higher risk of cardiac complications during pregnancy than the general population.  In general, a full evaluation including history, physical examination, echocardiogram, and electrocardiogram should be considered in the patient maternla patient with underlying heart disease.  Further risk stratification and monitoring are dictated by a number of factors, including the presence of prior cardiac events, [[heart failure]], [[valvular heart disease]], and systolic or diastolic dysfunction.   


==Cardiac Risk Score in Pregnancy==
==Cardiac Risk Score in Pregnancy==
A prospective study performed by Siu and colleagues identified four predictors of maternal cardiac events.<ref name="pmid11479246">{{cite journal| author=Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC et al.| title=Prospective multicenter study of pregnancy outcomes in women with heart disease. | journal=Circulation | year= 2001 | volume= 104 | issue= 5 | pages= 515-21 | pmid=11479246 | doi= | pmc= | url= }} </ref>  These include:
A prospective study performed by Siu and colleagues identified four predictors of maternal cardiac events.<ref name="pmid11479246">{{cite journal| author=Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC et al.| title=Prospective multicenter study of pregnancy outcomes in women with heart disease. | journal=Circulation | year= 2001 | volume= 104 | issue= 5 | pages= 515-21 | pmid=11479246 | doi= | pmc= | url= }} </ref>  These include:
*A prior cardiac event (e.g., heart failure, transient ischemic attack, or stroke before pregnancy) or arrhythmia
*A prior cardiac event (e.g., [[heart failure]], [[transient ischemic attack]], [[arrhythmia]] or [[stroke]]) before pregnancy
*A baseline New York Heart Association (NYHA) class higher than Class II or cyanosis
*A baseline [[New York Heart Association (NYHA) class]] higher than Class II [[heart failure]] or [[cyanosis]]
*A left-sided heart obstruction (mitral valve area smaller than 2 cm2, aortic valve area less than 1.5 cm2, or peak left ventricular outflow tract gradient more than 30 mm Hg by echocardiography
*A left-sided heart obstruction ([[mitral valve area]] smaller than 2 cm², [[aortic valve area]] less than 1.5 cm², or peak [[left ventricular outflow tract]] gradient more than 30 mm Hg by echocardiography
*Reduced systemic ventricular systolic function (ejection fraction less than 40%)
*Reduced left (or systemic) ventricular systolic function ([[ejection fraction]]) less than 40%


Based on this study of approximately 600 patients, the estimated risk of a cardiac event in pregnancies with 0, 1, and more than 1 point was 5%, 27%, and 75%, respectively.  The authors recommended that  those with a low cardiac risk of 0 could safely be delivered in a community hospital, but those at intermediate or high cardiac risk (risk score of 1 or more) should be delivered at a regional center.
Based on this study of approximately 600 patients, the estimated risk of a cardiac event in pregnancies with 0, 1, and more than 1 point was 5%, 27%, and 75%, respectively.  The authors recommended that  those with a low cardiac risk of 0 could safely be delivered in a community hospital, but those at intermediate or high cardiac risk (risk score of 1 or more) should be delivered at a regional center.
[[File:Pregnancy risk factors.PNG|Center|500px]]
It should be noted that severe [[pulmonary hypertension]] is associated with a 30-50% risk of maternal mortality.


==High Risk Valvular Lesions==
==High Risk Valvular Lesions==
The American College of Cardiology/American Heart Association (ACC/AHA) have developed guidelines that identify the following valvular lesions to be high risk during pregnancy<ref name="pmid18820172">{{cite journal| author=Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD et al.| title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=Circulation | year= 2008 | volume= 118 | issue= 15 | pages= e523-661 | pmid=18820172 | doi=10.1161/CIRCULATIONAHA.108.190748 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18820172  }} </ref>:
The American College of Cardiology/American Heart Association (ACC/AHA) guidelines designate the following valvular lesions as high risk during pregnancy<ref name="pmid18820172">{{cite journal| author=Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD et al.| title=2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=Circulation | year= 2008 | volume= 118 | issue= 15 | pages= e523-661 | pmid=18820172 | doi=10.1161/CIRCULATIONAHA.108.190748 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18820172  }} </ref>:
*Severe aortic stenosis
*Severe [[aortic stenosis]]
*Symptomatic mitral stenosis
*Symptomatic [[mitral stenosis]]
*Aortic or mitral regurgitation with NYHA class III to IV symptoms
*[[Aortic regurgitation]] or [[mitral regurgitation]] with [[NYHA class]] III to IV symptoms
*Aortic and/or mitral valve disease with left ventricular dysfunction (EF < 40%)
*Aortic and/or mitral valve disease with [[left ventricular dysfunction]] ([[left ventricular ejection fraction]] < 40%)
*Aortic and/or mitral valve disease with severe pulmonary hypertension (PA pressure > 75% of systemic pressure)
*Aortic and/or mitral valve disease with severe [[pulmonary hypertension]] ([[pulmonary artery]] (PA) pressure > 75% of systemic pressure)
*Marfan syndrome
*[[Marfan syndrome]]
*Mechanical prosthetic valve requiring anticoagulation
*Mechanical [[prosthetic valve]] requiring [[anticoagulation]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


{{WH}}
{{WS}}
[[CME Category::Cardiology]]


[[Category:Disease]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]
[[Category:Obstetrics]]
[[Category:Obstetrics]]
[[Category:Disease]]
[[Category:Cardiology board review]]
 
 
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Latest revision as of 20:48, 29 July 2020

Cardiac disease in pregnancy Microchapters

Home

Overview

Pathophysiology

Epidemiology and Demographics

Risk Factors

Diagnosis

History and Symptoms

Physical Examination

Electrocardiogram

Exercise Testing

Radiation Exposure

Chest X Ray

Echocardiography

MRI

CT

Catheterization:

Pulmonary artery catheterization
Cardiac catheterization
Cardiac Ablation

Treatment

Cardiovascular Drugs in Pregnancy

Labor and delivery

Resuscitation in Late Pregnancy

Contraindications to pregnancy

Special Scenarios:

I. Pre-existing Cardiac Disease:
Congenital Heart Disease
Repaired Congenital Heart Disease
Pulmonary Hypertension
Rheumatic Heart Disease
Connective Tissue Disorders
II. Valvular Heart Disease:
Mitral Stenosis
Mitral Regurgitation
Aortic Insufficiency
Aortic Stenosis
Mechanical Prosthetic Valves
Tissue Prosthetic Valves
III. Cardiomyopathy:
Dilated Cardiomyopathy
Hypertrophic Cardiomyopathy
Peripartum Cardiomyopathy
IV. Cardiac diseases that may develop During Pregnancy:
Arrhythmias
Acute Myocardial Infarction
Hypertension

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Anjan K. Chakrabarti, M.D. [2]

Overview

Women with acquired or congenital heart disease have a higher risk of cardiac complications during pregnancy than the general population. In general, a full evaluation including history, physical examination, echocardiogram, and electrocardiogram should be considered in the patient maternla patient with underlying heart disease. Further risk stratification and monitoring are dictated by a number of factors, including the presence of prior cardiac events, heart failure, valvular heart disease, and systolic or diastolic dysfunction.

Cardiac Risk Score in Pregnancy

A prospective study performed by Siu and colleagues identified four predictors of maternal cardiac events.[1] These include:

Based on this study of approximately 600 patients, the estimated risk of a cardiac event in pregnancies with 0, 1, and more than 1 point was 5%, 27%, and 75%, respectively. The authors recommended that those with a low cardiac risk of 0 could safely be delivered in a community hospital, but those at intermediate or high cardiac risk (risk score of 1 or more) should be delivered at a regional center.

Center

It should be noted that severe pulmonary hypertension is associated with a 30-50% risk of maternal mortality.

High Risk Valvular Lesions

The American College of Cardiology/American Heart Association (ACC/AHA) guidelines designate the following valvular lesions as high risk during pregnancy[2]:

References

  1. Siu SC, Sermer M, Colman JM, Alvarez AN, Mercier LA, Morton BC; et al. (2001). "Prospective multicenter study of pregnancy outcomes in women with heart disease". Circulation. 104 (5): 515–21. PMID 11479246.
  2. Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172.

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