HEART DISEASE IN PREGNANCY

Amal El Sayed

Cardiac Diseases in Pregnancy are Classified into:

Mitral Valve Prolapse: Rheumatic heart diseases Congenital heart diseases Cardiac arrhythmias Peripartum cardiomyopathy

New York Heart Association’s Functional Classification of Heart Disease

Class I: No sign or symptoms of cardiac decompensation

Class II: No symptoms at rest but minor limitation of physical activity

Class III: No symptoms at rest but marked limitation with physical activity

Class IV: Symptoms at rest, discomfort increases with any kind of physical activity

Rheumatic Heart Disease

Most common Heart disease in pregnancy Most common lesion is mitral stenosis The condition deteriorates with pregnancy due to

the increase in cardiac output. Asymptomatic patients may suffer from heart

failure or pulmonary edema Atrial Fibrillation and thromboembolic disease

may happen Other complications include subacute bacterial

endocarditis Antibiotic prophylaxis is essential. Penicillin is the

drug of choice

Congenital Heart Disease

Atrial Septal Defects Ventricular septal defects Primary pulmonary hyper tension Transposition of the great vesselsIf surgically corrected in childhood, patients

do well. If not, decompensation may happen in pregnancy with increase maternal mortality during pregnancy and post partum.

Cardiac Arrythmias

Supraventricular tachycardia is the most common.

Usually associated with cardiac structural defects.

Peripartum Cardio Myopathy

Rare No pre-exisiting cardiac lesions Occurs only in pregnancy Occurs with preeclampsia and HTN Dilation of heart chambers with heart

failure High mortality (at least 20%) If patient survives, condition may recurre.

Managemnt

Class I, II: Small risk Class III, IV: Big risk All cardiac patients should be managed by a

cardiologist ECG Echo Avoid excess weight gain Low-sodium diet to avoid edema Adequate rest to avoid stress Avoid anemia Anti Coagulation

Mode of Delivery

Vaginal, unless there is obstetric indication

But avoid pushing by using forceps or vacuum

Watch for fluid overload post-delivery, as this may precipitate heart failure

Renal Disease in Pregnancy

Asymptomatic Bacteruria

The presence of bacteria in urine without symptoms

Should be treated aggressively in pregnancy to avoid the development of UTI

UTI most common organism E coli. Common in pregnancy due to:

Stasis of urine Relaxation of urinary tract due to

progesterone effect

Pyelonephritis

Common due to: Stasis of urine due to dilation and

relaxation of urinary system Pressure of the uterus on the ureters

(especially right side)

Clinical Picture

Fever, chills Dysuria Frequency Loin pain Bacteria and pus in urine

IV hydration IV Antibiotics Analgesia The aim of treatment is to prevent

septicemia and premature labor

Treatment

Glomerulonephritis

1. Acute2. Chronic Causes destruction of renal parenchyma Secondary to infection or autoimmune

disorder

Clinical Picture

Fever Loin pain Casts in the urine Edema Protein urea Renal conditions become worse in

pregnancy May lead to HTN and preeclampsia

eclampsia

Treatment of the cause, and follow-up with KFTs which include: Na, K, CL, Bu, N, Creatine and Creatine clearance

Renal Failure

Acute: Usually secondary to hypovolemia

Chronic: Long standing renal damage