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Pregnancy and cardiac diseases

Pregnancy and cardiac diseases. Definition Pregnancy occurring in a lady who has got cardiac disease. Incidence. Relatively uncommon but significant adverse effects on maternal and fetal outcome 3-3.5% Serious heart disease complicating pregnancy is 1%. Pathophysiology.

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Pregnancy and cardiac diseases

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  1. Pregnancy and cardiac diseases Definition Pregnancy occurring in a lady who has got cardiac disease

  2. Incidence • Relatively uncommon but significant adverse effects on maternal and fetal outcome • 3-3.5% • Serious heart disease complicating pregnancy is 1%

  3. Pathophysiology • CVS changes during pregnancy overlap with cardiac disease • During pregnancy HR inc by 10% • Plasma volume expands by 40-50% • Co increases by 40% and further increases in labor • Premature atrial and ventricular beats are common • Peripheral pulses are of high volume confusing with aortic valve disease

  4. The neck veins pulsate more vigorously but the mean atrial pressure is unchanged • The heart size increases and apex beat may shift from mid clavicular line for up to 1 cm .a displacement of >2 cm should be considered abnormal • Odema is seen in normal pregnancy ,it is also feature of heart disease

  5. First heart sound is loud and third is audible • Systolic and diastolic murmurs are heard • Diseased heart compensated cardiac function before pregnancy may get decompensated during pregnancy and patient may go in to cardiac failure

  6. Cardiac disease may occur in two forms • Congenital: patent ductusarteriosis, atrial /ventricular septal defects, pulmonary stenosis ,Tetrology of Fallot • Acquired: Rheumatic heart disease, myocardial infarction, cardiomyopathy

  7. New York Heart Association Classification • Class 1:no limitation of physical activity ordinary physical activity does not cause undue fatigue, palpitations , dyspnoea ,or anginal pain • Class ii: slight limitation of physical activity , ordinary physical activity results in fatigue , palpitations , dyspnoea , or anginal pain

  8. Class iii: marked limitation of physical activity , less than ordinary activity causes fatigue, palpitation , dyspnoea , or anginal pain • Class iv :inability to perform any physical activity without discomfort, symptoms of cardiac insufficiency or anginal symptoms may be present even at rest , any physical activity increases discomfort

  9. Maternal and fetal effects • Maternal :limitation of physical activity causing repeated admissions • Maternal mortality is increased due to MS, pulmonary hypertension , myocardial infarction , cardiomyopathy • Fetal : increased incidence of abortion , IUGR premature delivery , intrauterine death • Increased perinatal mortality due to prematurity , decreased oxygen supply , congenital heart problem (2-4%)

  10. Risks of maternal morbidity and mortality • LOW RISKS : atrial and ventricular septal defects , pulmonic or tricuspid disease , mitral valve prolapse , PDA , corrected congenital heart disease , mitral stenosis NYHA class I or II • MODERATE RISK :Ms with atrial fibrillations , aortic stenosis ,artificial valve , coarctation of aorta , corrected Tetrology of Fallot

  11. High risk : pulmonary hypertension , complicated coarctation of aorta , Marfans syndrome with aortic involvement , NYHA class III or IV

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