Cardiovascular disease Cardiovascular disease in pregnancy in pregnancy

Dr.Z Allameh MD

A bout 1% heart disease

Rheumatic heart disease Congenital heart disease Hypertensive heart disease

Physiological considerations with heart disease in pregnancy

Hemodynamic changes Hemodynamic changes in N.l P in N.l P

Cardiac output +43Heart rate +17Left ventricular stroke work index +17Vascular resistance systemic -21Pulmonary -34Mean arterial pressure +4Colloid osmotic pressure -14

Diagnosis of heart disease

ElectroCardioGraphy Chest X-RAYEchocardiography

Clinical indicators of heart disease during pregnancySymptoms Progressive dyspnea or orthopneaNoctural cough ,Hemoptysis ,Syncope ,Chest pain Clinical findings Cyanosis ,clubbing of fingers Persistent neck vein distention Systolic murmur grade 3/6 or greater Diastolic murmur ,CardiomegalyPersistent arrhythmia Persistent split –second sound Criteria for pulmonary hypertension

Clinical classification Clinical classification

Class IClass IIClass IIIClass IV

Preconceptional counseling Preconceptional counseling

General management General management

Class I , II labor and delivery Group 1_ Minimal RiskAtrial septal defect Ventricular septal defect Patent ductus arteriosus Pulmonic or tricuspid disease Fallot tetralogy ,corrected Bioprosthetic valve Mitral stenosis ,NYHA

Group 2_ Moderate Risk Group 2_ Moderate Risk 5-15%5-15%

2A: Mitral stenosis ,NYHA classes III , IV Aortic stenosis Aortic coarctation without valvar involvement Fallot tetralogy ,uncorrected Previous myocardial infarction Marfan syndrome , normal aorta

2B:

Mitral stenosis with atrial fibrilation

Artificial valve

Group 3- Major Risk Group 3- Major Risk 25-25-50%50%

Pulmonary hypertension Aortic coarctation with valvar involvementMarfan syndrome with aortic involvement

Intrapartum heart failure Intrapartum heart failure

Management of class III , IVManagement of class III , IV