Cardiac disease in pregnancy overview

Cardiac disease in pregnancy Microchapters
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Overview
Pathophysiology
Epidemiology and Demographics
Risk Factors
Diagnosis
History and Symptoms
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Catheterization: Pulmonary artery catheterization Cardiac catheterization Cardiac Ablation
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Cardiovascular Drugs in Pregnancy
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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-In-Chief: Anjan K. Chakrabarti, M.D. [2]

Overview

Approximately 1-4% of pregnancies in the United States involve maternal cardiovascular disease. In fact, pregnancy can "unmask" underlying cardiovascular disease, due to hemodynamic changes associated with pregnancy. With a careful pre-pregnancy evaluation, most women with cardiovascular disease can have a pregnancy with proper care.

Epidemiology and Demographics

Increasing numbers of women with congenital heart disease are now reaching childbearing age, making congential heart disease the most common form of heart disease complicating pregnancy in the United States. Rheumatic heart disease is still prevalent in the developing world and in immigrant populations. Overall, maternal death during pregnancy in women with heart disease is rare, but certain conditions are associated with an increased mortality.

Disorders Associated with Cardiovascular Disease in Pregnancy

Maternal cardiovascular disease includes (most commonly) congenital disease, dilated and hypertrophic cardiomyopathies, valvular disease (with as mitral valve prolapse), pulmonary hypertension, and coronary disease. Other cardiovascular problems seen include cardiomyopathies, both dilated and hypertrophic, and valvular disease, such as bicuspid aortic valve and mitral valve prolapse. Less common problems include pulmonary hypertension and, rarely, coronary artery disease. Any of the above require a strategy regarding the frequency of follow-up by the cardiologist and a plan for labor and delivery.

Risk Factors

Siu et al. have developed a risk score for pregnant women with cardiovascular disease, and found that prior cardiac events or arrhythmia, poor functional class or cyanosis, left heart obstruction, and left ventricular systolic dysfunction independently predicted maternal cardiac complications.

References

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