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Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
Cardiac disease in pregnancy
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Cardiac disease in pregnancy

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  • 1. CARDIAC DISEASE IN PREGNANCY DR SHAMSA TARIQ ASSISTANT PROFESSOR GYNE /OBST UNIT II HOLY FAMILY HOSPITAL
  • 2. PHYSIOLOGIC CHANGES DURING PREGNANY     CO increases by 40%  as SV increases HR increases by 10 beats/min - 3rd trimester CO peaks at 18-24 wks then stabilize CO increase  grade II systolic flow murmur along the left sternal border without radiation
  • 3.       Diastolic murmur  if present consider pathologic  investigate IncreaseVR  Cardiac fullness & hypertrophy displacement of heart Apex beat  superiorly and laterally ECG Lt axis deviation Flattened T wave
  • 4. CARDIAC DISEASE 1. Rheumatic  90% of HD in pregnancy Reduces by 50% with better treatment of RHD and decrease pathogenisty of organism 2. Congenital  35% HD
  • 5. RHEUMATIC HEART DISEASE Mitral stenosis   Specific valvular disease Increase Risk of  Heart failure  SABE  Thromboembolic disease  Increase of fetal wastage
  • 6. MITRAL STENOSIS       90% During pregnancy  CO increase obstruction worsens Asymptomatic pt.  symptomatic Symptoms of cardiac decompensitions or pulmonary edema appear as pregnancy progresses Pt. with severe Mitral stenosis  Atrial fibrillation CCF. If Atrial fibrillation predates pregnancy  50% CCF.
  • 7. OTHER CARDIAC LESION  Mitral insufficency  Aortic stenosis
  • 8. CONGENITAL HEART DISEASE 1. 2. 3. 4. 5. Atrial septal defects Ventricular septal defects Fallot tetrology Primary Pulmonary hypertension (eisenmenger’s syndrome ) Cyanotic heart disease
  • 9. 1. Defects corrected in childhood with no residual damage pregnancy progresses without complication. 2. Atrial and ventricular septal defects + tetralogy of fallot tolerated pregnancy after surgical correction. 3. Maternal mortality increases by 25-50% in 4th and 5th condition (pregnancy and postpartum period)
  • 10. CAUSE OF DEATH Overload Pulmonary Congestion Hypotension Hypoxia Sudden death
  • 11. CARDIAC ARRHYTHMIAS Benign  Paroxysmal atrial tachycardia  Supraventicular tachycardia due to the structural changes in heart
  • 12. CARDIAC ARRHYTHMIAS Serious  Atrial fibrillation  Atrial flutter assosiated with underlying cardiac disease Management  same in pregnant & non pregnant
  • 13. PERIPARTUM & POSTPARTUM CARDIOMYOPATHY Rare  No etiological factor found  No underlying cardiac disease  Symptoms of cardiac decompensation appear during last weeks of pregnancy or ( 2-20wks) postpartum.
  • 14. Women prone to this condition gives h/o  Pre-eclampsia  Hypertension  Malnutrition
  • 15. MANAGEMENT NEW YORK HEART ASSOCIATION FUNCTIONAL CLASSIFICATION (NYHA) OF HEART DISEASE     CLASS I  No signs 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 of physical activity. CLASS IV  Symptoms present at rest increses discomfort with any kind of physical activity.
  • 16.  With I and II  Maternal and fetal  small  With III and IV Increases risk in both
  • 17. PRENATAL MANAGEMENT  Management with the help of cardiologist .  Frequent antenatal visit and admissions in class III and IV.
  • 18. GUIDELINES FOR MANAGEMENT 1. Avoid excessive weight gain and odema 2. Avoid sternuous activity 3. Avoid anemia 4. Early detection of a problem
  • 19. AVOID EXCESSIVE WEIGHT GAIN & ODEMA  Low sodium diet (2 gm/day)  Rest in left lateral position  Adequate sleep
  • 20. AVOID STERNUOUS ACTIVITY  Unable to increase CO  to meet demand of exercise  Extract more oxygen from arterial blood  large AV difference  uteroplacental circulation suffer
  • 21. AVOID ANEMIA  Oxygen carrying capacity decreases  increase CO  increase HR  Mitral stenosis worsens  increase heart rate  decrease in left ventricular filling time  pulmonary congestion  odema
  • 22. EARLY DETECTION OF A PROBLEM On each visit look for  Infection  Cardiac decompensation  Pulmonary congestion  Cardiac arrhythmias
  • 23. SYMPTOMS OF CARDIAC DECOMPENSATION      Pulse increases more than 100 bpm Engorged neck veins Increase JVP Liver, spleen enlarged and tender Weight gain and generalized edema Treatment  Digitalization  Diuretic
  • 24. SYMPTOMS OF PULMONARY CONGESTION 1. 2. 3. 4. Dyspnoea Orthopnea Pulmonary creptation Decrease vital capacity Mostly appear at  18-24 weeks  During labour  During delivery  Immediate postpartum
  • 25. MANAGEMENT OF LABOUR  CO increases  40-50% of pre-labour level  80% of pre-pregnancy  increase catecholamine release  pain and apprehension  abdominal and uterine muscle contractions
  • 26. TO MINIMIZE INCREASE CARDIAC OUTPUT  Assurance  Sedation  Epidural analgesia
  • 27. TO CONTROL INFECTION  Prophylactic antibiotic (penicilline – gentamylin)  Early labour  postpartum (1-2 weeks)
  • 28.  Left lateral position  decrease risk of supine hypotension  Increase oxygen carrying capacity of blood
  • 29. IN SEVERE CARDIAC DISEASE (III & IV)       Monitoring of CV status is essential arterial and swan- ganzcathetors Monitor  arterial pressure and CO with right atrial main pulmonary artery pressure Fluid intake and urine output Arterial blood gases Hemoglobin % Electrolytes
  • 30. INVOLVEMENT OF CARDIOLOGIST IS MUST DURING LABOUR, DELIVERY AND POSTPARTUM PERIOD
  • 31. OBSTETRICAL MANAGEMENT  Labour and foetal monitoring by using ext. electrode  Limit number of pelvic exam  Vaginal delivery preffered unless obstetrical indication for C section  Shorten 2nd stage  outlet  vacumn
  • 32.  Pushing avoided  increase CO due to increase VR  No ergometrine  Delivery of placenta increase 500 ml of blood so lower extremities should kept at lower level  No massage of uterus  Small postpartum hge is desirable.

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