This document discusses the approach to cardiac disease in pregnancy. It begins by outlining the normal physiological changes in pregnancy that place additional strain on the cardiovascular system. It then describes a systematic approach to evaluating and monitoring different types of cardiac lesions during pregnancy based on how well they are tolerated by the increased cardiovascular demands. High-risk cardiac conditions that require close monitoring and individualized treatment plans are also outlined.

1. Approach to Cardiac Disease in Pregnancy Mehul Bhatt, MD Athens Heart Center March 13, 2009

2. Approach to Cardiac Disease in Pregnancy Physiological changes in pregnancy Systematic approach to cardiac lesions Principal of monitoring and treatment Individualizing treatment to each patient

4. Normal Physiological Changes in Pregnancy Braunwald E et al. Heart Disease. 2001. pg. 2173.

5. Normal Physiological Changes in Pregnancy Braunwald E et al. Heart Disease. 2001. pg. 2173.

7. Normal Physiological Changes in Pregnancy Braunwald E et al. Heart Disease. 2001. pg. 2172.

15. Normal Physiological Changes in Pregnancy Hemodynamic Changes Postpartum Parameter Change Comment Blood Volume Decrease Blood loss CO Increase 60-80% immediate increase followed by rapid decrease, returns to normal levels in few weeks SV Increase HR Decrease BP Unchanged SVR Increase Loss of low resistance placenta

35. Cardiac Disease in Pregnancy: Prosthetic Valves Braunwald E et al. Heart Disease. 2001. pg. 2186.