Cardiac disease in pregnancy and hypertension

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Cardiac disease in pregnancy Microchapters

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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-In-Chief: Anjan K. Chakrabarti, M.D. [2] Stacie Zelman, M.D. [3]

Overview

Hypertension in pregnancy can be broadly classified as chronic hypertension, pregnancy-induced hypertension (or gestational hypertension), and pre-eclampsia/eclampsia. All of these conditions are the source of significant maternal morbidity and mortality.

Chronic Hypertension in Pregnancy

This condition is defined as hypertension (blood pressure ≥140 mm Hg systolic or ≥90 mm Hg diastolic) present before pregnancy or that is diagnosed before the 20th week of gestation. In general, antihypertensive medications are effective in treating this condition, in contrast to pre-eclampsia.[1]

Safe anti-hypertensive drugs that can be used during pregnancy include;

  1. Calcium channel blockers
  2. Lasix
  3. Beta-blockers
  4. Hydralazine
  5. Methyldopa

For a more broad discussion of chronic hypertension, click here.

Pregnancy-Induced Hypertension

Pregnancy-induced hypertension (PIH) (or gestational hypertension) is defined as the development of new arterial hypertension in a pregnant woman after 20 weeks gestation. There is no specific treatment, but is monitored closely to rapidly identify pre-eclampsia and its life-threatening complications (HELLP syndrome and eclampsia). Treatment options are limited, as many antihypertensives may negatively affect the fetus; methyldopa and labetalol are most commonly used for severe pregnancy hypertension.

Pre-Eclampsia/Eclampsia

References

  1. "Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy". Am J Obstet Gynecol. 183 (1): S1–S22. 2000. PMID 10920346.


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