Cardiac Disease
Incidence Cardiac Disease <ul><li>Ranges 0.5-2% </li></ul><ul><li>Rheumatic fever used to be responsible for 88% of cardia...
Etiology Cardiac Disease <ul><li>Rheumatic fever </li></ul><ul><li>Valve deformities </li></ul><ul><li>Congenital heart di...
Cardiac Disease – Diagnosis During Pregnancy <ul><li>Based on presentation of symptoms </li></ul><ul><li>If diagnosis not ...
Cardiac Disease –  General Management <ul><li>OB and cardiologist work together </li></ul><ul><li>Cardiac meds need to be ...
Cardiac Disease General Management <ul><li>Bedrest or restricted activity in last trimester for Class III </li></ul><ul><l...
Cardiac Disease – Drugs  <ul><li>Dependent on cardiac lesion (need to be concerned about fetal risks) </li></ul><ul><li>He...
Antepartum Physiology  <ul><li>Cardiac output    as early as 1 st  trimester </li></ul><ul><li>Continues to rise (due to ...
Intrapartum <ul><li>Work load of heart increased due to labor </li></ul><ul><li>Uterine contractions normally increase car...
Postpartum <ul><li>Remobilization of fluid after delivery into the intravascular compartment after placenta delivered </li...
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Cardiac disease

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Cardiac disease

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