Classification of Heart Disease in Pregnancy

PREPARED BY: CHUKWUMA I. ONYEIJE, M.D ATLANTA PERINATAL ASSOCIATES: http://chukwumaonyeije.com

A copy of this lecture can also be found at: http://onyeije.net/present

QUESTION #1: How can you classify heart function for pregnant women?

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

QUESTION #2: What is the MORTALITY associated with the various cardiac lesions ?

LOW RISK: Maternal Mortality less than 1%
Septal defects
NYHA Functional Class I
NYHA Functional Class II
Patent ductus arteriosus
Pulmonary / tricuspid lesions

MODERATE RISK: Maternal Mortality 5-15%
NYHA class III and IV mitral stenosis.
Aortic stenosis
Marfan’s syndrome with normal aorta
Uncomplicated coarctation of aorta
Past history of myocardial infarction

AORTIC STENOSIS (NARROW VALVE)

HIGH RISK: Maternal Mortality 25-50%
Eissenmenger’s syndrome.
Pulmonary hypertension.
Marfan’s syndrome with abnormal aortic root.
Peripartum cardiomyopathy.

QUESTION #3 What determines the prognosis for a woman with cardiac disease?

Prognosis Depends of Functional Status
NYHA classes I and II
Do well during pregnancy
Favorable prognosis
Mortality rate <1%.
NYHA classes III and IV
Mortality rate of 5% to 15%
These patients are generally advised NOT to b ecoming pregnant.

QUESTION #4: What are the clinical criteria for diagnosing cardiac disease DURING pregnancy ?

Criteria to diagnose cardiac disease during pregnancy:
Diastolic murmurs.
Severe Systolic Murmurs (grade 3).
Unequivocal enlargement of heart (X-ray).
Severe arrythmias
Atrial fibrillation
Atrial flutter

QUESTION #5: Cardiac Indications for Termination of Pregnancy? (Controversial)

Cardiac Conditions With Prohibitively High Maternal Risks:
Eisenmenger’s syndrome.
Marfan’s syndrome with aortic involvement
Pulmonary hypertension.
Coarctation of aorta with valvular involvement.
Termination is ideally performed before 12 weeks of pregnancy.

Classification of Heart Disease in Pregnancy

by Chukwuma Onyeije on Aug 07, 2011

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Classification of Heart Disease in Pregnancy — Presentation Transcript