Classification of Heart Disease in Pregnancy

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A presentation on the classification of heart disease during pregnancy.

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Classification of Heart Disease in Pregnancy

  1. 1. PREPARED BY: CHUKWUMA I. ONYEIJE, M.D ATLANTA PERINATAL ASSOCIATES: http://chukwumaonyeije.com
  2. 2. A copy of this lecture can also be found at: http://onyeije.net/present
  3. 3. QUESTION #1: How can you classify heart function for pregnant women?
  4. 4. The New York Heart Association (NYHA) Grading of Heart Functional Capacity: CLASS I No functional limitation of activity Symptoms with extra ordinary physical work. CLASS II Mild limitation of physical activity.   Symptoms with ordinary physical work CLASS III Marked limitation of physical activity Symptoms with less than ordinary physical work CLASS IV Severe limitation of physical activity Symptoms at rest
  5. 5. QUESTION #2: What is the MORTALITY associated with the various cardiac lesions ?
  6. 6. LOW RISK: Maternal Mortality less than 1% <ul><li>Septal defects </li></ul><ul><li>NYHA Functional Class I </li></ul><ul><li>NYHA Functional Class II </li></ul><ul><li>Patent ductus arteriosus </li></ul><ul><li>Pulmonary / tricuspid lesions </li></ul>
  7. 10. MODERATE RISK: Maternal Mortality 5-15% <ul><li>NYHA class III and IV mitral stenosis. </li></ul><ul><li>Aortic stenosis </li></ul><ul><li>Marfan’s syndrome with normal aorta </li></ul><ul><li>Uncomplicated coarctation of aorta </li></ul><ul><li>Past history of myocardial infarction </li></ul>
  8. 11. AORTIC STENOSIS (NARROW VALVE)
  9. 13. HIGH RISK: Maternal Mortality 25-50% <ul><li>Eissenmenger’s syndrome. </li></ul><ul><li>Pulmonary hypertension. </li></ul><ul><li>Marfan’s syndrome with abnormal aortic root. </li></ul><ul><li>Peripartum cardiomyopathy. </li></ul>
  10. 15. QUESTION #3 What determines the prognosis for a woman with cardiac disease?
  11. 16. Prognosis Depends of Functional Status <ul><li>NYHA classes I and II </li></ul><ul><ul><li>Do well during pregnancy </li></ul></ul><ul><ul><li>Favorable prognosis </li></ul></ul><ul><ul><li>Mortality rate <1%. </li></ul></ul><ul><li>NYHA classes III and IV </li></ul><ul><ul><li>Mortality rate of 5% to 15% </li></ul></ul><ul><ul><li>These patients are generally advised NOT to b ecoming pregnant. </li></ul></ul>
  12. 17. QUESTION #4: What are the clinical criteria for diagnosing cardiac disease DURING pregnancy ?
  13. 18. Criteria to diagnose cardiac disease during pregnancy: <ul><li>Diastolic murmurs. </li></ul><ul><li>Severe Systolic Murmurs (grade 3). </li></ul><ul><li>Unequivocal enlargement of heart (X-ray). </li></ul><ul><li>Severe arrythmias </li></ul><ul><ul><li>Atrial fibrillation </li></ul></ul><ul><ul><li>Atrial flutter </li></ul></ul>
  14. 19. QUESTION #5: Cardiac Indications for Termination of Pregnancy? (Controversial)
  15. 20. Cardiac Conditions With Prohibitively High Maternal Risks: <ul><li>Eisenmenger’s syndrome. </li></ul><ul><li>Marfan’s syndrome with aortic involvement </li></ul><ul><li>Pulmonary hypertension. </li></ul><ul><li>Coarctation of aorta with valvular involvement. </li></ul><ul><li>Termination is ideally performed before 12 weeks of pregnancy. </li></ul>

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