Transcript Cardiovascular disease in pregnancy

Cardiovascular disease
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
in N.l P
Cardiac output
Heart rate
Left ventricular stroke work index
Vascular resistance systemic
Pulmonary
Mean arterial pressure
Colloid osmotic pressure
+43
+17
+17
-21
-34
+4
-14
Diagnosis of heart disease
ElectroCardioGraphy
Chest X-RAY
Echocardiography
Clinical indicators of heart
disease during pregnancy
 Symptoms
Progressive dyspnea or orthopnea
Noctural cough ,Hemoptysis ,Syncope ,Chest pain
 Clinical findings
Cyanosis ,clubbing of fingers
Persistent neck vein distention
Systolic murmur grade 3/6 or greater
Diastolic murmur ,Cardiomegaly
Persistent arrhythmia
Persistent split –second sound
Criteria for pulmonary hypertension
Clinical classification
Class I
Class II
Class III
Class IV
Preconceptional counseling
General management
Class I , II
labor and delivery
Group 1_ Minimal Risk
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
Pulmonic or tricuspid disease
Fallot tetralogy ,corrected
Bioprosthetic valve
Mitral stenosis ,NYHA
Group 2_ Moderate Risk
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
25-50%
Pulmonary hypertension
Aortic coarctation with valvar involvement
Marfan syndrome with aortic involvement
Intrapartum heart failure
Management of class III , IV