cardiovascular disorders in pregnancy
PG REVIEW
HEART DISEASES IN PREGNANCY
MODERATOR: PROF SUNIL AGARWAL
STUDENT: ANKIT KUMAR SAHU
INTRODUCTION
Heart disease is the second most common cause of maternal death in Western countries, suicide being first1. According to CDC, heart disease is the leading cause of death in women who are 25 to 44 yrs old2. Maternal cardiac disease in a pregnant woman can present challenges in cardiovascular and maternal-fetal management thereby leading to significant non-obstetric maternal morbidity and mortality3. Approximately 1% of pregnancies are complicated by cardiac disease and the management of these cases can challenge the entire team providing care to the mother and fetus4.
Women with congenital heart disease currently accounting for approximately 30-50% of all cardiac diseases in pregnancy5, now far outnumber those with rheumatic heart disease in pregnancy except in developing countries where 90% of all heart disorders in women of child-bearing age are of rheumatic origin. Advances in the treatment of congenital heart disease have made it possible for more affected children to reach adulthood and attempt pregnancy. Many women are postponing childbearing until the fourth and fifth decades of life6 and with advancing maternal age, underlying medical conditions such as hypertension, diabetes, and hypercholesterolemia the incidence of acquired heart disease complicating pregnancy is increasing7.
The purpose of this article is to review the clinical features of incipient maternal cardiac disease and address recent advances in the management of these patients, and to consider the management of pregnant women known to have cardiac disease before delivery.
PHYSIOLOGICAL CARDIOVASCULAR ADAPTATION IN PREGNANCY
Pregnancy is associated with several cardiocirculatory changes that can significantly impact underlying cardiac disease. Knowledge of these cardiovascular adaptations is required to correctly interpret hemodynamic and
HEART DISEASES IN PREGNANCY
MODERATOR: PROF SUNIL AGARWAL
STUDENT: ANKIT KUMAR SAHU
INTRODUCTION
Heart disease is the second most common cause of maternal death in Western countries, suicide being first1. According to CDC, heart disease is the leading cause of death in women who are 25 to 44 yrs old2. Maternal cardiac disease in a pregnant woman can present challenges in cardiovascular and maternal-fetal management thereby leading to significant non-obstetric maternal morbidity and mortality3. Approximately 1% of pregnancies are complicated by cardiac disease and the management of these cases can challenge the entire team providing care to the mother and fetus4.
Women with congenital heart disease currently accounting for approximately 30-50% of all cardiac diseases in pregnancy5, now far outnumber those with rheumatic heart disease in pregnancy except in developing countries where 90% of all heart disorders in women of child-bearing age are of rheumatic origin. Advances in the treatment of congenital heart disease have made it possible for more affected children to reach adulthood and attempt pregnancy. Many women are postponing childbearing until the fourth and fifth decades of life6 and with advancing maternal age, underlying medical conditions such as hypertension, diabetes, and hypercholesterolemia the incidence of acquired heart disease complicating pregnancy is increasing7.
The purpose of this article is to review the clinical features of incipient maternal cardiac disease and address recent advances in the management of these patients, and to consider the management of pregnant women known to have cardiac disease before delivery.
PHYSIOLOGICAL CARDIOVASCULAR ADAPTATION IN PREGNANCY
Pregnancy is associated with several cardiocirculatory changes that can significantly impact underlying cardiac disease. Knowledge of these cardiovascular adaptations is required to correctly interpret hemodynamic and