Cardiac disease in pregnancy

2. Introduction
• Heart disease in pregnancy is very rare but
potentially serious.
• If the heart is already compromised by an
existing anomaly, this can result in a poor
outcome for both fetus and mother.
• The onset of pregnancy marks the beginning of
changes in the physiology of the cardiovascular
system.
• Pregnancy in a patient with existing heart
disease should be a carefully planned

3. Cardiovascular Changes in
Pregnancy
• Most pregnant women develop fatigue , shortness
of breath, Decreased exercise capacity,palpitations .
• Some times peripheral edema , jugular venous
distension , audible systolic flow murmer .
• This is explained by:changes occurring during 1st 5 -
8 weeks of pregnancy and reach the peak by the
end of 2nd trimester . These changes includes :

4. 1.Increases Cardiac output
• A. Preload: is increased
• B. Afterload: is reduced
• Cardiac output increases 10-20%
2.Increased in Heart Rate 10-15 b/min.
3.Change in Blood pressure

5. 4.Increased liability
of varicose vein
due to :
• i. Pressure of
gravid uterus on
pelvic veins .
• ii. Relaxation of
smooth muscle
fibers in the
blood vessel wall
by progesterone .
• iii. Increase in the
blood volume .

6. Diagnosis of Cardiac Disease
History Taking
Examination
Investigation

7. Clinical Features of
Normal
pregnancy Mimic
Heart Disease
SYMPTOMS :
Clinical indications of
the Heart
Disease during
pregnancy
SYMPTOMS :
1.Dyspnea.
2.Orthopnoea.
3. Paroxysmal
Nocturnal Dyspnea.
4. Easy fatigue.
5. Dizziness.
1. Progressive
Dyspnea or
Orthopnoea.
2. Chest pain.
3. Nocturnal Cough.
4. Hemoptysis.
5. Syncope.
Sr.
no
Clinical Features of
Normal
pregnancy Mimic Heart
Disease
SIGNS :
Clinical indications of the
Heart
Disease
during pregnancy
SIGNS :
1.
2.
3.
4.
Dyspnea
Orthopnea
Paroxysmal
Nocturnal Dyspnea
Easy fatigue
Progressive Dyspnea or
Orthopnea
Chest pain
Nocturnal Cough
Hemoptysis
Syncope.

8. Sr.no Clinical Features of Normal
pregnancy Mimic Heart
Disease
SIGNS :
Clinical indications of the
Heart
Disease
during pregnancy
SIGNS :
1.
2.
3.
4.
5.
Increased Pulse Rate
Water Hummer Pulse.
Systolic Murmur.
Edema.
congested Neck veins.
Cyanosis.
Clubbing Of fingers.
Arrhythmia.
Pulmonary HTN.
Cardiomegaly .
Systolic & Diastolic

9. Investigations
• Full Cardiovascular Examination includes Blood
tests (CBC , BTCT)
• Enzyme study (Troponin I) & CPK
• Echocardiogram :cardiac status and structural
anomalies
• ECG
• CXR ( Chest X ray ) : Assess cardiac size & Outline
• Other Imaging : CT Scan , MRI of the Chest
• Angiography

10. Effects of Cardiac Disease in Pregnancy
• Fetal
complications :
• Abortion
• IUGR
• IUFD
• Preterm labour
• Early neonatal
death
• Maternal
complications :
• Polyhydraminos
( part of systemic
venous congestion)
• Preterm labour
• Postpartum
hemorrhage

11. Classification
• 1) Rheumatic Heart Disease
 (i)Aortic valve Stenosis
 (ii) Mitral Valve Stenosis
• 2) Congenital Heart Disease(Most Common)
 Acyanotic CHD ( L to R Shunt)
 Cyanotic CHD (R to Left Shunt)
 Other CHD
 Coronary Artery Disease (CAD)

12. 1. Rheumatic Heart Disease
• Rheumatic heart Disease causes inflammation &
scarring of the Heart Valves & results in Valve
Stenosis,with/without Regurgitation.
• caused By a reaction to a bacterial infection with
group a streptococcus.
• The Mitral Valve is most often affected with Stenosis
 (i)Aortic Valve Stenosis
 (ii) Mitral Valve Stenosis

14. Acyanotic Heart Disease
• Blood is shunted (flows) from the left side of
the heart to the right side of the heart due to a
structural defect (hole) in the interventricular
septum.
• Rheumatic heart disease in pregnancy Acute
rheumatic fever is an illness caused By a reaction
to a bacterial infection with group a streptococcus.

15. • most common CHD,which may remain
uncorrected during the child bearing
years,are ASD , PDA , VSD.
• All of these are openings,which allow
communication between the right & left
sides of the Heart or case of PDA between
the Pulmonary Artery & Aorta.
• Problems arise when pulmonary vascular
resistance rises,as it does in Pre eclempsia,

17. Ventricular Septal Defect (VSD)

18. Patent Ductus Arteriosus (PDA)

19. Aortic & Mitral Regurgitation

20. 2. Cyanotic Heart Disease
(i) Tetralogy of Fallot:
A combination of four heart defects..
1. Ventricular septal defect (VSD): A hole between the
two ventricles, of the heart that permits oxygen-poor
blood from the right ventricle to mix with oxygen-rich
blood from the left ventricle.
2.Pulmonary stenosis: Narrowing of the outlet to the
pulmonary artery area with an abnormal pulmonary
valve impeding blood flow from the right ventricle to
the lungs.

21. 3.Right ventricular hypertrophy (RVH):Thickening and
enlargement of the muscle of the right ventricle.
4.Overriding Aorta: A case in which the aorta overrides or
straddles the wall (the septum) between the ventricles,
permitting oxygen-poor blood to flow through the VSD into
the aorta.

23. (ii) Eisenmenger’s Syndrome
• It’s defined as the process in which a long-standing
left-to-right cardiac shunt caused by a congenital
heart defect causes pulmonary hypertension and
eventual reversal of the shunt into a cyanotic right-
to-left shunt.
• Eisenmenger's syndrome in a pregnant mother can
cause serious complications.

25. 3.Other CHD
• (iii) Coarctation of Aorta:
• The word "coarctation" means narrowing. Coarctations
are most common in the aortic arch.
• Coarctation of the aorta (CoA or CoAo), also called
aortic narrowing, is a congenital condition whereby
the aorta is narrow, usually in the area where the
ductus arteriosus inserts.

27. Heart Murmur:
 It is a sound produced at the time of heart beat.
 This is commonly developed in pregnant women
because of high blood volumes in the body.
 But one should seek doctors’ advice to control or
prevent it depending upon the situation.

28.  Previous pregnancy with complication
 Underlying heart disease
 Underlying kidney disease
 Rheumatic illness
 A history of previous blood clot
 Obesity , smoking high B.P,Diabetes

29. • Pain in the chest &
joints
• Fast heart rate
• Abnormal heart beat
• Fatigue
• Fever
• Poor or over weight
• Persistent cough
• Fainting
• Loud snoring
• Throat or jaw pain

30. • Monitor the woman's vital signs
• Monitor fetal stages
• Complete a dietary history & modify Diet
• The patient should be In lateral recumbent position
to minimise aorto-caval compression
• oxygen is to be administered if required
NURSING MANAGMENT

31. • Fluids should not be infused than 75 ml/hour to
prevent pulmonary edema
• Careful watch of the pulse and respiration rate.
• Cardiac monitoring and pulse oxymetry cab detect
arrhythmias

32. • Propped up position
• O2 administration
• Monitoring with ECG & pulse oxymetry
• Give diuretic
• Mechanical ventilation
• Injection morphine
MANAGEMENT OF CARDIAC FAILURE
IN PREGNANCY

33. control the risk
1.Quit smoking:
 The smoke will spoil lungs and other organs and
leads to increase the risk of heart diseases leads
to abortion.
2.Improve Cholesterol levels:
 Bad cholesterol affects body and changes the
heart functionality.
3. Control high blood pressure:
High blood pressure will result in various cardiac
disease in pregnancy and if not treated properly it
may lead to abnormalities to the baby

34. 4.Follow a heart-healthy Diet:
 Never skip any of the meals. Follow a healthy diet.
5. Control Diabetics:
• Diabetics has the major impact of both body and
heart during pregnancy.
6. Manage stress:
• Stress may cause many internal body and mental
tensions and changes to the person.
• This may lead to depression and can cause various
heart diseases.

35. 7.Healthy Foods:
 Eat healthy foods prescribed by the doctors Skip
various unsaturated, stored foods.
8. Exercise:
• There are special exercises, yoga, and meditation for
pregnancy womens.
9. Water:
• Always prefer to drink warm water during
pregnancy
• Never drink bottled water or chill water.

36. THANK YOU