Download Heart Disease In Pregnancy

Amal El Sayed
 Mitral
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Valve Prolapse:
Rheumatic heart diseases
Congenital heart diseases
Cardiac arrhythmias
Peripartum cardiomyopathy
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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
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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
Atrial Septal Defects
 Ventricular septal defects
 Primary pulmonary hyper tension
 Transposition of the great vessels
If surgically corrected in childhood, patients do
well. If not, decompensation may happen in
pregnancy with increase maternal mortality
during pregnancy and post partum.
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Supraventricular tachycardia is the most
common.
Usually associated with cardiac structural
defects.
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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.
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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
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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
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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
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Common due to:
 Stasis of urine due to dilation and relaxation of
urinary system
 Pressure of the uterus on the ureters (especially
right side)
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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
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Acute
Chronic
Causes destruction of renal parenchyma
Secondary to infection or autoimmune disorder
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Fever
Loin pain
Casts in the urine
Edema
Protein urea
Renal conditions become worse in pregnancy
May lead to HTN and preeclampsia eclampsia
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Treatment of the cause, and follow-up with
KFTs which include: Na, K, CL, Bu, N, Creatine
and Creatine clearance
Acute: Usually secondary to hypovolemia
 Chronic: Long standing renal damage
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