Hypertrophic cardiomyopathy management during pregnancy

Hypertrophic Cardiomyopathy Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Hypertrophic Cardiomyopathy from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X Ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Interventions
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Hypertrophic cardiomyopathy management during pregnancy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Hypertrophic cardiomyopathy management during pregnancy
CDC on Hypertrophic cardiomyopathy management during pregnancy
Hypertrophic cardiomyopathy management during pregnancy in the news
Blogs on Hypertrophic cardiomyopathy management during pregnancy
Directions to Hospitals Treating Hypertrophic cardiomyopathy
Risk calculators and risk factors for Hypertrophic cardiomyopathy management during pregnancy

Editors-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Women with hypertrophic cardiomyopathy should be managed by a skilled cardiovascular specialist and a high-risk obstetrician during pregnancy. Any activity, drug or circumstance that increases left ventricular outflow obstruction, reduced left ventricular filling, or increases left ventricular afterload should be avoided.

Natural History, Complications And Prognosis In The Hypertrophic Cardiomyopathy Patient During Pregnancy

Among HCM patients who chronically have mild symptoms, pregnancy is generally well tolerated . Although pregnancy causes vasodilation which should exacerbate the outflow gradient, pregnancy also causes fluid retention and an increase in plasma volume which increases preload and offsets the reduction in afterload. In a series of 100 HCM patients, only one of 28 asymptomatic patients developed NYHA Class III or IV heart failure. Among 12 previously symptomatic patients, 5 patients developed NYHA Class III or IV heart failure. It is notable that two sudden deaths occurred in this series of 100 patients. One of the two patients had a resting gradient of 115 mm Hg. The other patient had a markedly positive family history with 8 family members sustaining any early death, 5 of which were sudden death .

Avoid Activities That Increase Left Ventricular Outflow Tract Obstruction

The following activities increase left ventricular outflow tract obstruction and should be avoided:

• Nausea and vomiting
• Dehydration
• Hypovolemia (i.e., use diuretics with caution)
• Medications that reduce preload and left ventricular filling such as nitrates

Avoid Activities That Increase Afterload

The following activities increase left ventricular afterload should be avoided:

• Intense isometric exercise

Beta Blockade and Calcium Channel Blockade

Although both beta blockers and verapamil may improve symptoms in the mother, the dosing should be limited to minimize the risk of fetal bradycardia, growth retardation and hypoglycemia. There is more experience with the use beta blockers during pregnancy.

Home Delivery Should Be Avoided

Home delivery without IV access is not preferred.

Vaginal Delivery Versus C-Section

Vaginal delivery is usually successful.