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    Heart Disease in Pregnancy

    Uploaded by

    Ankur Shah

    Copyright:

    © All Rights Reserved
    Download as ODP, PDF, TXT or read online from Scribd

    Heart Disease in Pregnancy

    Uploaded by

    Ankur Shah
    11 views20 pages

    Copyright

    © © All Rights Reserved

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    Copyright:

    © All Rights Reserved
    Download as ODP, PDF, TXT or read online from Scribd
    Download as odp, pdf, or txt
    11 views20 pages

    Heart Disease in Pregnancy

    Uploaded by

    Ankur Shah

    Copyright:

    © All Rights Reserved
    Download as ODP, PDF, TXT or read online from Scribd
    Download as odp, pdf, or txt
    You are on page 1of 20

    HEART DISEASE IN PREGNANCY

    The Heart Cycle

    3
    Heart Sounds

    4
    Physiological Changes in Pregnancy
    ●
    Changes in hemodynamic functions:
    – Increased blood volume
    – Decreased systemic vascular resistance
    ●
    Cardiac function changes:
    – Increased preload
    – Increased heart rate
    – Increased stroke volume

    5
    ●
    Structural changes in heart:
    – Enlarged left ventricle
    – Cardiac plasticity

    6
    7
    8
    QUIZ

    9
    Symptoms of Cardiac Disease

    10
    11
    Clinical Indicators of Heart Disease in
    Pregnancy
    ●
    Symptoms ●
    Clinical Findings
    – Progressive dyspnoea – Cyanosis, Clubbing
    – Orthopnoea – Persistent neck vein
    – Nocturnal cough distention
    – Haemoptysis
    – Systolic murmur > 3/6
    – Syncope
    – Diastolic murmur
    – Chest Pain
    – Persistent Split S2, S4
    – Cardiomegaly
    – Tachycardia / Arrhythmia

    12
    Risk Classification
    ●
    Functional:
    – NYHA classification
    – Class I & II:
    ●
    Do well during pregnancy
    ●
    Favourable prognosis
    ●
    Mortality rate <1%
    – Class III & IV:
    ●
    Mortality rate 5 – 15%
    ●
    Not advised pregnancy

    13
    WHO Risk Classification

    14
    General Considerations in Pregnancy
    ●
    Pre-conceptional care:
    – Optimizing cardiac function
    – Risk of similar congenital heart disease in neonate
    – Anticoagulant drugs
    ●
    Risk factors:
    – Race/Ethnicity: African-American women
    – Age: >40 years
    – Hypertension
    – Obesity
    15
    ●
    Antepartum Care:
    – Multidisciplinary approach
    – Regular cardiac consultation
    – Early recognition of heart failure, infection/sepsis
    – Bacterial endocarditis prophylaxis

    16
    ●
    Labour & Delivery:
    – Cesarean limited to obstetric indications, except:
    ●
    Dilated aortic root >4 cm or aneurysm, severe aortic stenosis
    ●
    Acute severe CHF
    ●
    Recent MI
    ●
    Warfarin administration within 2 weeks of delivery (fetal intracerebral
    haemorrhage)
    – Semi-recumbent position with lateral tilt
    – Labour Analgesia
    – Cut short second stage of labour
    17
    Complications
    ●
    Maternal:
    – Heart Failure:
    ●
    Highest at 20 – 24 weeks, during delivery and immediate post-partum
    – Anemia, Infections
    – Post partum haemorrhage
    – Preterm delivery
    – Thromboembolism

    18
    ●
    Fetal:
    – Abortions
    – Preterm labour
    – IUGR
    – Intrauterine Fetal demise
    – Congenital Heart disease – 5%
    – Drug induced congenital malformations
    – Intracerebral/ventricular haemorrhage

    19
    20

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