This document discusses heart disease in pregnancy. It begins by noting that heart disease complicates around 1% of pregnancies. It then covers cardiovascular changes in pregnancy like increased blood volume and cardiac output. Grades of cardiac disease severity are described. Diagnosis involves history, exams, ECGs, echocardiograms. Effects on the fetus and mother are outlined. Classifications of cardiac diseases seen in pregnancy like rheumatic heart disease and congenital heart diseases are summarized. Nursing management focuses on monitoring, positioning, oxygen supplementation and controlling cardiac failure. Guidelines for pregnant women with heart disease emphasize treating existing conditions, testing for defects, controlling risks, and regular consultations.

3. Thought of The Day

4. Content
Introduction
Grading of Cardiac disease
Classification
Causes
Sign & Symptoms
Nursing Management

6. Introduction
• Heart disease in pregnancy is very
rare but potentially serious and
complicates approximately 1% of all
pregnancies. the incidence of
rheumatic heart disease and
undiagnosed or uncorrected
congenital heart disease is higher in
developing countries.

7. Cont… • 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 progressive and
profound changes in the
physiology of the cardiovascular
system.
• Pregnancy in a patient with
existing heart disease should be
a carefully planned

8. 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 :

9. • Increased Blood
Volume by 20 –
40 % during
pregnancy and
reach the peak
at 32nd week
remained at
high level to
delivery occur .

10. • A. Preload: is
increased due to
associated Rise in
the blood
volume.
• B. Afterload: is
reduced due to
the decline in
systemic vascular
resistance.
• Cardiac output
increases 10-20%
Increases Cardiac
output

11. • Increased in
Heart Rate
10-15
b/min.

12. • systolic Decreased
by 5 – 10 mm/Hg
• diastolic decreased
by 10 – 15 mm/Hg
• Due to
vasodilatation
caused by :
• i. Placenta acts as
arterio – venous
shunt thus decrease
peripheral
resistance.

13. • 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 .

14. Grades by NYHA(New york
Heart Association
Classification)

15. Grade Symptoms Degree of
compromise
I No limitation of physical activity-
asymptomatic with
normal activity
Uncompromised
II Mild limitation of physical activity -
Symptoms with
normal physical activity
Slightly
compromised
III Marked limitation of physical
activity -Symptoms
with less than normal activity,
comfortable at rest
Markedly
compromised
IV Severe limitation of physical
activity- symptoms at
Severely
compromised

16. Diagnosis of Cardiac Disease
History Taking
Examination
Investigation

17. 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.

18. 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

19. 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

20. 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
( Cx is congested )
• Postpartum
hemorrhage

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

22. 1. Rheumatic Heart Disease
• Rheumatic heart Disease causes
inflammation & scanning of the Heart
Valves & results in Valve
Stenosis,with/without Regurgitation.
• The Mitral Valve is most often affected
with Stenosis ( occurring in 2/3rd of
cases)
 (i)Aortic Valve Stenosis
 (ii) Mitral Valve Stenosis

24. Congenital Heart Disease

25. Acyanotic Heart Disease
• An acyanotic heart defect, also known
as non-cyanotic heart defect, is a class
of congenital heart defects. In these,
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.

26. Cont…
• 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,

28. Ventricular Septal Defect
(VSD)

29. Patent Ductus Arteriosus
(PDA)

30. Aortic & Mitral
Regurgitation

32. 2. Cyanotic Heart Disease
• (i) Tetralogy of Fallot:
• A combination of four heart defects..
• Ventricular septal defect (VSD): A hole
between the two bottom chambers, the
ventricles, of the heart that permits
oxygen-poor blood from the right ventricle
to mix with oxygen-rich blood from the left
ventricle.
• 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.

33. Cont…
• Right ventricular hypertrophy
(RVH):Thickening and enlargement of
the muscle of the right ventricle.
• 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.

35. (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(typically by a ventricular septal
defect, atrial septal defect, or less
commonly, patent ductus arteriosus)
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.

37. 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.

39. (ii) Marfan Syndrome
• A hereditary genetic disorder of connective
tissue, resulting in abnormally long and thin
digits and also frequently in optical and
cardiovascular defects.
• People with Marfan tend to be tall, and thin,
with long arms, legs, fingers, and toes.They
also typically have flexible
joints and scoliosis. The most serious
complications are the heart and aorta with
an increased risk of mitral valve
prolapse and aortic aneurysm.Other
commonly affected areas include the lungs,
eyes, bones, and the covering of the spinal
cord.

41. Coronary Artery Disease in
Pregnancy
 Myocardial infarction of coronary
artery disease complication during
pregnancy is a rare complication.
 It occurs due to the increase in
cholesterol, low-density lipoprotein, and
decrease in high-density lipoproteins.
 The best cardiologist surgeon in
Hyderabad report says 1 in 10,000 may
affect with this during pregnancy.

43. 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.

44.  Previous pregnancy with
complication
 Underlying kidney disease
 Underlying heart disease
 Rheumatic illness
 A history of previous blood clot

48. • Pain in the chest & joints
• Fast heart rate
• Abnormal heart beat
• Fatigue
• Fever

53. Throat or Jaw pain

54. • Monitor the woman's vital signs, level of
mobility, level of consciousness.
• Monitor fetal status.
• Psychosocial issues such as levels of
stress, exposure to
• abuse and violence
• Complete a dietary history & modify Diet
• counseling

55. The patient should be In lateral
recumbent position to minimise aorto-
caval compression
• oxygen is to be administered if
required
• 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

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

57. Decrease and control the risk
 Quit smoking:
 If a pregnancy woman has smoking
habit, it should be Stop
 The smoke will spoil lungs and other
organs and leads to increase the risk
in many heart diseases.
 There are chance of even abortions
and other complications to both
mother and baby if not quitted.

60. Improve cholesterol levels:
 Bad cholesterol affects body and
changes the heart functionality.
 Improve the cholesterol levels and
destroy the bad cholesterol from body.
 This will reduce obesity and improve
health.

62. 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.

64. Follow a heart-healthy
Diet:
 Never skip any of the meals. Follow a
healthy diet which helps in providing
rich amount of proteins, minerals,
nutrients and other healthy
components to the body.
 Always consult doctor during
pregnancy period to know the foods to
avoid and foods to be taken more to
protect baby from any sort of
abnormalities and diseases.

66. Control Diabetics:
 Diabetics has the major impact of
both body and heart during
pregnancy.
 Few pregnant women may affect with
diabetics during pregnancy and cure
by themselves after the delivery of the
baby with the proper treatment and
medication.

68. 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.
 Stress management is the priority of
every pregnancy woman.
 Unnecessary tensions should be
avoided and always be happy and
peaceful.

70. Healthy Foods:
 Eat healthy foods prescribed by
the doctors by concentrating on
Do’s and Don’ts of the food
menu.
 Eat quality and organic foods.
 Skip various unsaturated, stored
foods which harm both parent
and child and can cause various
defects in the child.

72. Exercise:
 There are special exercises, yoga,
and meditation for pregnancy
women.
 No woman should follow normal
exercises or yoga process during
pregnancy time as they may lead
to abortions.
 Always do this process in the
guidance of experienced
professional.

74. Water:
 As we all know about water and
its essentials.
 Always prefer to drink warm
water during pregnancy and
prefer water instead of cool
drinks or other drinks.
 Never drink bottled water or
chill water.
 Maintain a separate water bottle
with warm water and carry
where ever you go.

75. Heart disease in pregnancy
guidelines
 Treat the diseases you already have
whether it is related to heart or any
other disease.
 Test for birth defects and genetic
conditions.
 Check and control pregnancy related
complication if had in past.
 Make pregnant woman stress free
and always keep your body and mind
in relaxed state.

76. Cont…
 Monthly consultations are must and
medication should be taken in time.
 Never change multiple doctors
during pregnancy follow only one
clinic and doctor till the end.
 Adopt for pregnancy yoga and
exercise which helps in ease
delivery.