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Cardiac disease
Cardiac disease
Cardiac disease
Cardiac disease
Cardiac disease
Cardiac disease
Cardiac disease
Cardiac disease
Cardiac disease
Cardiac disease
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Cardiac disease


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  • 1. Cardiac Disease
  • 2. Incidence Cardiac Disease
    • Ranges 0.5-2%
    • Rheumatic fever used to be responsible for 88% of cardiac disease
    • Now responsible for @50%
    • Congenital heart disease now more prominent but since better management in childhood pregnancy outcomes generally positive
    • Mitral valve prolapse is most frequently seen valve defect in pregnant women
  • 3. Etiology Cardiac Disease
    • Rheumatic fever
    • Valve deformities
    • Congenital heart disease
    • Developmental abnormalities
    • Congestive cardiomyopathies
    • Cardiac Dysrhythmias
  • 4. Cardiac Disease – Diagnosis During Pregnancy
    • Based on presentation of symptoms
    • If diagnosis not already known usually made by cardiologist
    • Tests
      • ECG
      • Lab tests (cardiac enzymes and electrolytes_
      • Chest Xray
  • 5. Cardiac Disease – General Management
    • OB and cardiologist work together
    • Cardiac meds need to be compatible with pregnancy
    • Dosages of meds adjusted when signs and symptoms worsen
    • Early US to help with dating
    • @28 weeks US to determine fetal growth and well being
    • EFM and BPP usually started @ 24 weeks
  • 6. Cardiac Disease General Management
    • Bedrest or restricted activity in last trimester for Class III
    • Possible limitations for Classes I and II (but not usually necessary)
    • First big hurtle @28 – 32 weeks (Maximum volume present)
    • If Rheumatic fever then antibiotics
    • Everything aimed at < cardiac workload
    • Vaginal delivery preferred if possible
    • Critical care monitoring may be needed for severe cardiac problems
  • 7. Cardiac Disease – Drugs
    • Dependent on cardiac lesion (need to be concerned about fetal risks)
    • Heparin
    • Lasix
    • Digitalis
    • Beta blockers
    • Antidysrhythmics
  • 8. Antepartum Physiology
    • Cardiac output  as early as 1 st trimester
    • Continues to rise (due to  in plasma volume)
    • Reaches plateau between @28-32 weeks
    • Signs and symptoms similar to those of cardiac disease
      • Dyspnea
      • Orthopnea
      • Dyspnea with exertion
      • Occasional palpatations
      • Edema
      • Fatigue
  • 9. Intrapartum
    • Work load of heart increased due to labor
    • Uterine contractions normally increase cardiac output and stroke volume because of the increased intravascular volume
    • Positioning very important
      • Laterally
      • Providing pain relief as needed
  • 10. Postpartum
    • Remobilization of fluid after delivery into the intravascular compartment after placenta delivered
    • Important to be cautious with IV fluids and Pitocin after delivery (risk of pulmonary edema)