Heart disease complicating pregnancy (1).pdf

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1. Heart disease
complicating
pregnancy

3. Introduction
Hearth disease in pregnancy..
•Major cause of maternal death
•Congenital heart diseases
•Acquired heart diseases
•Rheumatic heart disease
•Chronic valvular heart disease following Rheumatic fever in
childhood
•Incidence now low in most developed countries.
•Usually affecting the mitral or aortic valves

4. Physiological adaptations of the cardiovascular
system to pregnancy, labourand delivery
•Blood volume increases from the 5
th
week of gestation
•Plasma volume increases grater than red cell mass
resulting in physiological anemia.
•Cardiac output increases due to increased heart rate
as well as the stroke volume

5. •Heart rate increases by 10-20 bpm
•Blood volume and stroke volume increases by about
30 to 50% by the end of the 2
nd
trimester
•Labouris associated with further increase in COP(15%
in the first stage and 50% in the second stage of
labour)

6. •In the third stage of labourup to a liter of blood may be
returned to the circulation due to the relief of IVC
obstruction and contraction of the uterus
•The intra thoracic cardiac blood volume rise.
•COP increases by 60-80%followed by a rapid decline to pre-
labourvalues within about one hour of delivery.
•Woman with cardiovascular compromise are therefore most
at risk during the second stage of labourand the immediate
post partum period.

7. Signs and Symptoms
Symptoms
•Shortness of breathing on mild
to moderate exertion
•Orthopnoea
•Palpitation
•Chest pain
Signs
•Tachycardia
•Murmurs on auscultation of the
heart
•Cyanosis
•Oedema
•Basal crepitations

8. Investigation
•ECG
•Echocardiography
•CT scan (MRI)
•Angiography

9. Congenital heart disease
Acyanoticheart disease
•Atrial septal defect(ASD)
•Ventricular septal defect(VSD) and patent arterial duct (PDA)
•Pulmonary stenosis
•Aortic stenosis-left ventricular outflow tract obstruction is a high risk
condition.
•Co-arctationof the Aorta
•Marfanssyndrome

10. Cyanotic heart disease
•Tetralogy of Fallots
•Post operative congenital heart disease
•Eisernmengerssyndrome and pulmonary hypertension

11. Acquired heart disease
•Mitral valve prolapse
•Rheumatic heart disease
•Mitral stenosis-worldwide the most common and potentially lethal
pre existing heart lesion in pregnancy
•Mechanical heart valves
•Coronary heart disease
•Hypertropiccardiomyopathy
•Peripartum cardiomyopathy
•Arrhythmias

12. Management
•Highest cardiac risk
•Mitral stenosis
•Aortic stenosis
•Hypertropiccardiomyopathy
•Pulmonary hypertension
•Patient should be managed by a team of obstetricians, cardiologist
and anaesthetistand a plan of management drawn up
•Wherever possible cardiac treatment should be given prior to
pregnancy and pregnancy delayed until treatment is completed
•In cases where the outcome can be total termination of pregnancy
should be offered

13. •Elective delivery may be more appropriate in some cases
with an elective caesarean section
•Endocarditis prophylaxis should be started where
appropriate
•Patients in labourshould have cardiovascular monitoring
throughout labourand the immediate post partum period.
•Oxygen inhalation and prop up in bed may be necessary

14. •Second stage of labourcan be shortened with forceps
or ventousedelivery
•Ergometrine should not be used for the 3
rd
stage of
labour, syntocinoncan be used instead.
•Post partum contraceptive advice should be given.

15. Thank You….!