Heart Disease In Pregnancy

1. Heart Disease In Pregnancy Amal El Sayed

2. Cardiac Diseases in Pregnancy are Classified into: • Mitral Valve Prolapse: • Rheumatic heart diseases • Congenital heart diseases • Cardiac arrhythmias • Peripartumcardiomyopathy

3. New York Heart Association’s Functional Classification of Heart Disease • Class I: No sign or symptoms of cardiac decompensation • Class II: No symptoms at rest but minor limitation of physical activity • Class III: No symptoms at rest but marked limitation with physical activity • Class IV: Symptoms at rest, discomfort increases with any kind of physical activity

4. Rheumatic Heart Disease • Most common Heart disease in pregnancy • Most common lesion is mitral stenosis • The condition deteriorates with pregnancy due to the increase in cardiac output. • Asymptomatic patients may suffer from heart failure or pulmonary edema • Atrial Fibrillation and thromboembolic disease may happen • Other complications include subacutebacterial endocarditis • Antibiotic prophylaxis is essential. Penicillin is the drug of choice

5. Congenital Heart Disease • AtrialSeptal Defects • Ventricular septal defects • Primary pulmonary hyper tension • Transposition of the great vessels If surgically corrected in childhood, patients do well. If not, decompensation may happen in pregnancy with increase maternal mortality during pregnancy and post partum.

6. Cardiac Arrythmias • Supraventricular tachycardia is the most common. • Usually associated with cardiac structural defects.

7. Peripartum Cardio Myopathy • Rare • No pre-exisiting cardiac lesions • Occurs only in pregnancy • Occurs with preeclampsia and HTN • Dilation of heart chambers with heart failure • High mortality (at least 20%) • If patient survives, condition may recurre.

8. Managemnt • Class I, II: Small risk • Class III, IV: Big risk • All cardiac patients should be managed by a cardiologist • ECG • Echo • Avoid excess weight gain • Low-sodium diet to avoid edema • Adequate rest to avoid stress • Avoid anemia • Anti Coagulation

9. Mode of Delivery • Vaginal, unless there is obstetric indication • But avoid pushing by using forceps or vacuum • Watch for fluid overload post-delivery, as this may precipitate heart failure

10. Renal Disease in Pregnancy

11. Asymptomatic Bacteruria • The presence of bacteria in urine without symptoms • Should be treated aggressively in pregnancy to avoid the development of UTI • UTI most common organism E coli. • Common in pregnancy due to: • Stasis of urine • Relaxation of urinary tract due to progesterone effect

12. Pyelonephritis Common due to: • Stasis of urine due to dilation and relaxation of urinary system • Pressure of the uterus on the ureters (especially right side)

13. Clinical Picture • Fever, chills • Dysuria • Frequency • Loin pain • Bacteria and pus in urine

14. Treatment • IV hydration • IV Antibiotics • Analgesia The aim of treatment is to prevent septicemia and premature labor

15. Glomerulonephritis • Acute • Chronic • Causes destruction of renal parenchyma • Secondary to infection or autoimmune disorder

16. Clinical Picture • Fever • Loin pain • Casts in the urine • Edema • Protein urea • Renal conditions become worse in pregnancy • May lead to HTN and preeclampsia eclampsia

17. Treatment of the cause, and follow-up with KFTs which include: Na, K, CL, Bu, N, Creatine and Creatine clearance

18. Renal Failure • Acute: Usually secondary to hypovolemia • Chronic: Long standing renal damage