This document summarizes diagnostic algorithms for ventricular tachycardia (VT), including the Brugada algorithm and Vereckei algorithm. The Brugada algorithm uses three steps - absence of RS complex, R-S interval over 100ms, and checking for AV dissociation. The Vereckei algorithm only uses lead aVR and analyzes initial R wave dominance, QRS width over 40ms, notching, and V initial/V terminal ratio. The document also discusses differentiating VT from supraventricular tachycardia with aberrancy based on morphology, duration, and symptoms.
Primary PCI involves performing urgent angioplasty and potentially stenting of the culprit artery in STEMI patients, with the goal of reopening the blocked vessel within 90 minutes of first medical contact. It is the preferred reperfusion strategy when it can be performed promptly by an experienced team. Factors such as patient age, time to treatment, comorbidities, and initial flow in the artery help determine whether primary PCI or thrombolysis is most appropriate. Optimal anticoagulation and antiplatelet regimens along with adjunctive therapies like manual thrombectomy can improve outcomes of primary PCI.
La anomalía de Ebstein describe una malformación cardíaca congénita caracterizada por la malformación e implantación anómala de las válvulas tricúspidea septal y posterior, lo que da origen a una porción atrializada anormal del ventrículo derecho. Esto puede producir insuficiencia cardíaca, cianosis y arritmias en recién nacidos. El tratamiento depende de la gravedad de los síntomas y puede incluir medicamentos, cirugía de reparación o univentricular, o ablación en algunos casos.
Insuficiencia Mitral y Ecocardiograma; Por: Dr. Ricardo Mora Moreno MAECO (Fellow Ecocardiografia Adultos); 17 Enero 2020; Ciudad de Mexico; IMSS CMN Hospital de Cardiologia SS XXI
This document summarizes diagnostic algorithms for ventricular tachycardia (VT), including the Brugada algorithm and Vereckei algorithm. The Brugada algorithm uses three steps - absence of RS complex, R-S interval over 100ms, and checking for AV dissociation. The Vereckei algorithm only uses lead aVR and analyzes initial R wave dominance, QRS width over 40ms, notching, and V initial/V terminal ratio. The document also discusses differentiating VT from supraventricular tachycardia with aberrancy based on morphology, duration, and symptoms.
Primary PCI involves performing urgent angioplasty and potentially stenting of the culprit artery in STEMI patients, with the goal of reopening the blocked vessel within 90 minutes of first medical contact. It is the preferred reperfusion strategy when it can be performed promptly by an experienced team. Factors such as patient age, time to treatment, comorbidities, and initial flow in the artery help determine whether primary PCI or thrombolysis is most appropriate. Optimal anticoagulation and antiplatelet regimens along with adjunctive therapies like manual thrombectomy can improve outcomes of primary PCI.
La anomalía de Ebstein describe una malformación cardíaca congénita caracterizada por la malformación e implantación anómala de las válvulas tricúspidea septal y posterior, lo que da origen a una porción atrializada anormal del ventrículo derecho. Esto puede producir insuficiencia cardíaca, cianosis y arritmias en recién nacidos. El tratamiento depende de la gravedad de los síntomas y puede incluir medicamentos, cirugía de reparación o univentricular, o ablación en algunos casos.
Insuficiencia Mitral y Ecocardiograma; Por: Dr. Ricardo Mora Moreno MAECO (Fellow Ecocardiografia Adultos); 17 Enero 2020; Ciudad de Mexico; IMSS CMN Hospital de Cardiologia SS XXI
This document discusses peripheral pulmonary artery stenosis, including its description, associated conditions, classification, clinical features, diagnosis using imaging modalities like echocardiography and angiography, and treatment options like balloon angioplasty. Peripheral pulmonary artery stenosis can involve the main pulmonary artery or its branches and is present in 2-3% of congenital heart disease cases. Diagnosis relies on cardiac catheterization and angiography to determine severity and anatomy. Balloon angioplasty is an option for treating moderate or severe stenosis when surgery is difficult.
- Left atrial appendage (LAA) closure devices provide a less invasive alternative to surgical LAA closure for stroke prevention in atrial fibrillation patients. The WATCHMAN and Amplatzer Cardiac Plug are the most widely used devices.
- Major trials like PROTECT AF have demonstrated the efficacy and safety of LAA closure with the WATCHMAN device. FDA approval is pending for its use in warfarin-eligible patients.
- Percutaneous LAA closure procedures involve transseptal access and deployment of self-expanding nitinol devices into the LAA orifice. Complete sealing of the LAA is confirmed prior to device release.
Early repolarization (ER) is an ECG pattern characterized by J-point elevation. While historically considered a benign variant, recent studies have linked ER to an increased risk of arrhythmia. ER syndrome describes those with both ER on ECG and symptomatic arrhythmias like ventricular fibrillation. Diagnosis requires excluding other causes through testing of survivors of sudden cardiac death. While the ER pattern itself usually requires no treatment, an implantable cardioverter-defibrillator is recommended for secondary prevention in ER syndrome patients with a history of resuscitated sudden cardiac death.
Este documento resume una presentación sobre la reserva de flujo coronario fraccionada (FFR) en un congreso de cardiología intervencionista. Explica que la FFR mide la fracción del flujo coronario máximo que puede alcanzarse a través de una estenosis, y que estudios como DEFER y FAME han demostrado que la FFR puede guiar decisiones de revascularización versus tratamiento médico óptimo para mejorar resultados para los pacientes.
This document discusses pulmonary stenosis (PS), a congenital heart defect where the pulmonary valve is narrowed. It accounts for 20-30% of congenital heart disease. PS can be valvular, subvalvular, or supravalvular. Symptoms range from none to right heart failure. Diagnosis involves listening for a systolic murmur and click, and imaging like echocardiogram and catheterization to measure pressures and gradients. Treatment is usually balloon valvuloplasty or surgery if severe.
SCAD is a rare, sometimes fatal, traumatic condition with approximately eighty percent of cases affecting women. The coronary artery can suddenly develop a tear, causing blood to flow between the layers which forces them apart, potentially causing a blockage of blood flow through the artery and a resulting heart attack. The condition may be related to female hormone levels, as it is often seen in post-partum women, or in women during or very near menstruation, but not always. It is not uncommon for SCAD to occur in people in good physical shape and with no known prior history of heart related illness. It is also not uncommon for SCAD to occur in people in their 20's, 30's, and 40's, as well as older.
El documento presenta información sobre el síndrome isquémico coronario agudo. Explica los criterios clínicos, electrocardiográficos y bioquímicos para establecer el diagnóstico e iniciar el tratamiento según el contexto. También reconoce las principales complicaciones para disminuir la mortalidad y mejorar el pronóstico. El caso clínico presentado describe a un hombre de 63 años con dolor torácico que acude a urgencias, con antecedentes de infarto y factores de riesgo cardiovascular.
Brugada Syndrome is a genetic disorder characterized by abnormal ECG patterns and increased risk of ventricular arrhythmias. It is caused by mutations in genes encoding sodium channels. Typical ECG findings include ST elevation in leads V1-V3. Risk factors include spontaneous type 1 ECG pattern, family history of sudden cardiac death, and inducible arrhythmias on electrophysiology study. Diagnosis requires type 1 ECG pattern plus symptoms or family history of events.
Natural history and treatment of aortic stenosisKunal Mahajan
This document discusses the natural history and treatment of aortic stenosis. It defines the severity classifications based on aortic jet velocity, mean gradient, and valve area. Symptoms rarely occur with severe aortic stenosis if left ventricular function is normal. The document reviews progression rates in asymptomatic patients and risk factors for more rapid progression. Exercise testing may help identify higher risk asymptomatic patients but is not routinely recommended. Biomarkers like BNP levels can also predict outcomes. The prognosis is poor once patients become symptomatic, so surgical intervention is recommended for symptomatic severe aortic stenosis.
Coronariopatia No Idoso - Como indicar estudo hemodinâmico?Márcio Borges
1) A cineangiografia é um método importante para avaliar doença arterial coronariana em idosos. 2) Stents representam um grande avanço no tratamento de doença coronariana em idosos, melhorando sobrevida e qualidade de vida. 3) Estudos atuais sugerem que stents farmacológicos são seguros e efetivos quando usados conforme indicações, reduzindo reestenose.
A 47-year-old male presented with angina and a history of hypertension and smoking. Tests showed T-wave inversion and normal left ventricular function. He underwent bifurcation stenting of a true bifurcation lesion where both the main branch and side branch were significantly narrowed. The current preferred approach for treating non-true bifurcations is provisional stenting of the main vessel with optional stenting of the side branch. A two-stent strategy may be used for large side branches supplying a significant area of myocardium, especially when the side branch arises at a shallow angle.
This document discusses the diagnosis of myocardial infarction (MI) in the presence of bundle branch blocks. It notes that bundle branch blocks can make ECG diagnosis of MI more difficult by altering depolarization patterns. For right bundle branch block, the criteria for diagnosing a Q-wave MI are the same as normal conduction. For left bundle branch block, the Sgarbossa criteria (ST elevation concordant with QRS, ST depression in V1-V3, discordant ST elevation ≥5mm) have high specificity but low sensitivity for acute MI diagnosis. Certain ECG patterns like abnormal Q waves may suggest prior infarction despite left bundle branch block.
O documento descreve as principais doenças da aorta, incluindo dissecção aguda da aorta, aneurisma da aorta e coarctação da aorta. Detalha os sintomas, exames de diagnóstico e tratamentos para cada condição. Também fornece recomendações para a assistência de enfermagem no pós-operatório destas doenças.
Guidelines and beyond new drug therapy for heart failure with reduced ejectio...ahvc0858
This document provides information on new guidelines and therapies for heart failure patients. It begins by outlining the challenges of managing heart failure patients and their high mortality rates. It then discusses the history of heart failure treatments from ACE inhibitors in the 1990s to newer drugs like ARNi's. The document defines the different types of heart failure - HFrEF, HFmrEF, and HFpEF - and their diagnostic criteria. It explains how neprilysin inhibition enhances natriuretic peptides while simultaneously suppressing the RAAS. Finally, it summarizes that the new drug LCZ696 combines neprilysin inhibition with an ARB to reduce mortality and hospitalization in heart failure patients beyond existing neurohormonal therapies
Este documento proporciona información sobre la evaluación ecocardiográfica de las comunicaciones interauriculares. Explica que existen diferentes tipos como el ostium secundum, ostium primum y seno venoso, y describe cómo se ven y miden cada uno. También cubre temas como la cuantificación del flujo pulmonar sistémico (QP:QS), el uso del ecocardiograma transesofágico, y los signos ecocardiográficos de hipertensión pulmonar como la presión arterial sistólica en la arteria pulmon
This document discusses peripheral pulmonary artery stenosis, including its description, associated conditions, classification, clinical features, diagnosis using imaging modalities like echocardiography and angiography, and treatment options like balloon angioplasty. Peripheral pulmonary artery stenosis can involve the main pulmonary artery or its branches and is present in 2-3% of congenital heart disease cases. Diagnosis relies on cardiac catheterization and angiography to determine severity and anatomy. Balloon angioplasty is an option for treating moderate or severe stenosis when surgery is difficult.
- Left atrial appendage (LAA) closure devices provide a less invasive alternative to surgical LAA closure for stroke prevention in atrial fibrillation patients. The WATCHMAN and Amplatzer Cardiac Plug are the most widely used devices.
- Major trials like PROTECT AF have demonstrated the efficacy and safety of LAA closure with the WATCHMAN device. FDA approval is pending for its use in warfarin-eligible patients.
- Percutaneous LAA closure procedures involve transseptal access and deployment of self-expanding nitinol devices into the LAA orifice. Complete sealing of the LAA is confirmed prior to device release.
Early repolarization (ER) is an ECG pattern characterized by J-point elevation. While historically considered a benign variant, recent studies have linked ER to an increased risk of arrhythmia. ER syndrome describes those with both ER on ECG and symptomatic arrhythmias like ventricular fibrillation. Diagnosis requires excluding other causes through testing of survivors of sudden cardiac death. While the ER pattern itself usually requires no treatment, an implantable cardioverter-defibrillator is recommended for secondary prevention in ER syndrome patients with a history of resuscitated sudden cardiac death.
Este documento resume una presentación sobre la reserva de flujo coronario fraccionada (FFR) en un congreso de cardiología intervencionista. Explica que la FFR mide la fracción del flujo coronario máximo que puede alcanzarse a través de una estenosis, y que estudios como DEFER y FAME han demostrado que la FFR puede guiar decisiones de revascularización versus tratamiento médico óptimo para mejorar resultados para los pacientes.
This document discusses pulmonary stenosis (PS), a congenital heart defect where the pulmonary valve is narrowed. It accounts for 20-30% of congenital heart disease. PS can be valvular, subvalvular, or supravalvular. Symptoms range from none to right heart failure. Diagnosis involves listening for a systolic murmur and click, and imaging like echocardiogram and catheterization to measure pressures and gradients. Treatment is usually balloon valvuloplasty or surgery if severe.
SCAD is a rare, sometimes fatal, traumatic condition with approximately eighty percent of cases affecting women. The coronary artery can suddenly develop a tear, causing blood to flow between the layers which forces them apart, potentially causing a blockage of blood flow through the artery and a resulting heart attack. The condition may be related to female hormone levels, as it is often seen in post-partum women, or in women during or very near menstruation, but not always. It is not uncommon for SCAD to occur in people in good physical shape and with no known prior history of heart related illness. It is also not uncommon for SCAD to occur in people in their 20's, 30's, and 40's, as well as older.
El documento presenta información sobre el síndrome isquémico coronario agudo. Explica los criterios clínicos, electrocardiográficos y bioquímicos para establecer el diagnóstico e iniciar el tratamiento según el contexto. También reconoce las principales complicaciones para disminuir la mortalidad y mejorar el pronóstico. El caso clínico presentado describe a un hombre de 63 años con dolor torácico que acude a urgencias, con antecedentes de infarto y factores de riesgo cardiovascular.
Brugada Syndrome is a genetic disorder characterized by abnormal ECG patterns and increased risk of ventricular arrhythmias. It is caused by mutations in genes encoding sodium channels. Typical ECG findings include ST elevation in leads V1-V3. Risk factors include spontaneous type 1 ECG pattern, family history of sudden cardiac death, and inducible arrhythmias on electrophysiology study. Diagnosis requires type 1 ECG pattern plus symptoms or family history of events.
Natural history and treatment of aortic stenosisKunal Mahajan
This document discusses the natural history and treatment of aortic stenosis. It defines the severity classifications based on aortic jet velocity, mean gradient, and valve area. Symptoms rarely occur with severe aortic stenosis if left ventricular function is normal. The document reviews progression rates in asymptomatic patients and risk factors for more rapid progression. Exercise testing may help identify higher risk asymptomatic patients but is not routinely recommended. Biomarkers like BNP levels can also predict outcomes. The prognosis is poor once patients become symptomatic, so surgical intervention is recommended for symptomatic severe aortic stenosis.
Coronariopatia No Idoso - Como indicar estudo hemodinâmico?Márcio Borges
1) A cineangiografia é um método importante para avaliar doença arterial coronariana em idosos. 2) Stents representam um grande avanço no tratamento de doença coronariana em idosos, melhorando sobrevida e qualidade de vida. 3) Estudos atuais sugerem que stents farmacológicos são seguros e efetivos quando usados conforme indicações, reduzindo reestenose.
A 47-year-old male presented with angina and a history of hypertension and smoking. Tests showed T-wave inversion and normal left ventricular function. He underwent bifurcation stenting of a true bifurcation lesion where both the main branch and side branch were significantly narrowed. The current preferred approach for treating non-true bifurcations is provisional stenting of the main vessel with optional stenting of the side branch. A two-stent strategy may be used for large side branches supplying a significant area of myocardium, especially when the side branch arises at a shallow angle.
This document discusses the diagnosis of myocardial infarction (MI) in the presence of bundle branch blocks. It notes that bundle branch blocks can make ECG diagnosis of MI more difficult by altering depolarization patterns. For right bundle branch block, the criteria for diagnosing a Q-wave MI are the same as normal conduction. For left bundle branch block, the Sgarbossa criteria (ST elevation concordant with QRS, ST depression in V1-V3, discordant ST elevation ≥5mm) have high specificity but low sensitivity for acute MI diagnosis. Certain ECG patterns like abnormal Q waves may suggest prior infarction despite left bundle branch block.
O documento descreve as principais doenças da aorta, incluindo dissecção aguda da aorta, aneurisma da aorta e coarctação da aorta. Detalha os sintomas, exames de diagnóstico e tratamentos para cada condição. Também fornece recomendações para a assistência de enfermagem no pós-operatório destas doenças.
Guidelines and beyond new drug therapy for heart failure with reduced ejectio...ahvc0858
This document provides information on new guidelines and therapies for heart failure patients. It begins by outlining the challenges of managing heart failure patients and their high mortality rates. It then discusses the history of heart failure treatments from ACE inhibitors in the 1990s to newer drugs like ARNi's. The document defines the different types of heart failure - HFrEF, HFmrEF, and HFpEF - and their diagnostic criteria. It explains how neprilysin inhibition enhances natriuretic peptides while simultaneously suppressing the RAAS. Finally, it summarizes that the new drug LCZ696 combines neprilysin inhibition with an ARB to reduce mortality and hospitalization in heart failure patients beyond existing neurohormonal therapies
Este documento proporciona información sobre la evaluación ecocardiográfica de las comunicaciones interauriculares. Explica que existen diferentes tipos como el ostium secundum, ostium primum y seno venoso, y describe cómo se ven y miden cada uno. También cubre temas como la cuantificación del flujo pulmonar sistémico (QP:QS), el uso del ecocardiograma transesofágico, y los signos ecocardiográficos de hipertensión pulmonar como la presión arterial sistólica en la arteria pulmon
Bassa frequenza di eventi tromboembolici ed emorragici con l’uso peri-procedurale di edoxaban in pazienti anziani con FA/TEV sottoposti a procedure diagnostiche e terapeutiche
This document discusses the treatment of pulmonary arterial hypertension (PAH), including:
- Approved PAH therapies such as endothelin receptor antagonists, phosphodiesterase-5 inhibitors, and prostanoids.
- The three main pathways involved in PAH pathogenesis.
- Treatment recommendations for PAH associated with congenital heart disease, including the use of PAH-specific therapies.
- Evidence that PAH-specific therapies can reduce mortality in patients with Eisenmenger syndrome.
- Lung transplantation is an option for patients with inadequate response to maximal PAH therapy.
H trattamento dell’ipertensione arteriosa polmonareguch-piemonte
This document discusses the treatment of pulmonary arterial hypertension. Pulmonary arterial hypertension has several underlying causes, with the most common being idiopathic pulmonary arterial hypertension at around 50% of cases. Medications are the primary treatment and work to dilate blood vessels and improve heart function. These include endothelin receptor antagonists, phosphodiesterase type-5 inhibitors, prostanoids, and soluble guanylate cyclase stimulators. In severe cases, lung transplantation may be considered.
2. • Modificazioni fisiologiche della
gravidanza
• Epidemiologia delle cardiopatie in
gravidanza
• Rischi materno fetali della gravidanza,
del parto e del post partum
5. Portata cardiaca, volume plasmatico
e frequenza cardiaca
Resistenze vascolari periferiche e PAO
Emodiluizione con anemia relativa (Hb 10.5 g/dl)
1. Maggior impegno emodinamico
Pressione venosa centrale <->
6. Portata cardiaca, volume plasmatico
e frequenza cardiaca
Emodiluizione con anemia relativa (Hb 10.5 g/dl)
1. Maggior impegno emodinamico
Pressione venosa centrale <->
7. 2. Stato trombofilico (↑ fattori VII, VIII, IX, X, XII,
del fibrinogeno e del fattore von Willebrand):
rischio trombotico 6x in gravidanza e 12x in
puerperio.
3. Stato “proinfiammatorio“: potenti agenti
antiangiogenetici (sVEGFR1) secreti dalla placenta
danneggiano il letto vascolare-> rischio di
dissecazione pareti vascolari e cardiache.
Royal College of Physicians, 2012
8. PARTO:
- Aumento del consumo di O2
- Durante ciascuna contrazione
uterina viene immesso in circolo un
volume ematico di 300-500 ml
- Manovra di Valsalva
- Aumento della gittata cardiaca del
180% rispetto ai valori pregravidici
POSTPARTUM:
Aumento del ritorno venoso per
risoluzione della compressione aorto-
cavale
Rientro in circolo di sangue
sequestrato dalla placenta
Aumento del precarico e della
gittata cardiaca
Hunter et al. Br Med J 1992
Southern Medical Association 2013
9.
10. … anche le Pazienti affette da
cardiopatia hanno desiderio di
maternità!
MIGLIORAMENTI
CHIRURGIA
PEDIATRICA
AUMENTO FATTORI
DI RISCHIO
CARDIOVASCOLARI
0.2-4 % delle gravidanze è
complicato da cardiopatia
European Society Cardiology Guidelines 2011
11. • Malattie cardiache congenite
Sono le malattie cardiovascolari più frequenti in gravidanza
nei paesi industrializzati (70-80%); rare nei paesi in via di
sviluppo (10-20%)
• Malattie valvolari cardiache acquisite
sono le patologie cardiache prevalenti nei paesi in via di
sviluppo (50-90%), 15% nei paesi industrializzati
• Cardiomiopatie: rare ma molto gravi.
• Malattia coronarica: rara ma con un trend in aumento.
12. CRITERI DI INCLUSIONE
Donne in gravidanza con CARDIOPATIE STRUTTURALI: valvolari,
congenite, cardiomiopatie, ischemiche
CRITERI DI ESCLUSIONE
Aritmie in cuore sano
Arruolamento retrospettivo dal 1° gennaio 2007, prospettico dal
2008 ad oggi
www.escardio.org
:45 paesi, 129 centri di arruolamento
22. • CARPREG:
score per cardiopatie congenite e valvolari
(Siu 2001)
• ZAHARA:
score esclusivamente per cardiopatie congenite
(Drenthen 2010)
• WHO:
suddivisione delle cardiopatie in 4 classi di rischio
(WHO 1998; Thome 2006)
23. Raccomandato dal gruppo di lavoro dell’American Heart Association (2010)
con integrazione di cardiopatia e comorbidità della singola paziente
FREQUENZA RACCOMANDATA
DI FOLLOW-UP CARDIOLOGICO
(Numero visite) IN GRAVIDANZA
1-2
3
5-9
5-9 in caso di
prosecuzione
gravidanza
28. WHO 1 WHO 2 WHO 3 WHO 4 P-value
Apgar score <7
(%)
4.1 10 11 17 0.001
Foetal death (%) 0.4 0.6 2.8 5.7 0.001
Neonatal death
(%)
1.2 0.4 0.4 0.0 0.24
Birth weight (g)
3109 3074 2925 2735 <0.001
Pregnancy
duration (weeks) 39 38 38 37 <0.001
European Heart Journal (2013) 34, 657–665
29. I rischi fetali dipendono dalla cardiopatia materna, dalla funzionalità
ventricolare e valvolare materna, dalla classe funzionale, dalla presenza
di cianosi e dall’impiego di anti-coagulanti.
European Heart Journal 2011
32. Survival
and
Intact
Survival
Survival
rate
Intact
Survival
Baschat
2007
604
neonates
Mean
BW
600
g
(500
–
1500)
33.
34. Uebing A et al. BMJ 2006;332: 401; Siu SC et al. Heart 2001; 85: 710
Rischio di
cardiopatia fetale
nella popolazione
generale: 0,8%
S. di Marfan= autosomica dominante: rischio di ricorrenza del 50%
Ecocardiografia fetale!!!
37. • TERAPIA PERCUTANEA:
- Possibilmente nel II trimestre
(organogenesi completa, tiroide inattiva, utero piccolo)
- Dose di esposizione fetale 3mGy (<50 mGy non rischio malformativo,
problemi neurologici, restrizione di crescita)
- Ridurre al minimo la durata dell’esposizione e schermare l’utero
• CHIRURGIA CARDIACA CON BYPASS CARDIOPOLMONARE
- Solo se pericolo di vita per la madre, meglio 13-28 settimane di EG
- Mortalità materna in gravidanza = non in gravidanza
- Morbidità neonatale 3-6% (problemi neurologici), elevata mortalità
fetale
- Se EG>28 sett: valutare taglio cesareo prima della chirurgia
- Ciclo di corticosteroidi prima della chirurgia
38. Prediligere parto per via vaginale
Utilizzo dell'analgesia peridurale
Evitare il prolungamento del secondo stadio del
travaglio (eventuale parto operativo)
Monitoraggio materno intrapartum e postpartum
(ECG, saturazione O2, ev.monitoraggio invasivo
della pressione arteriosa)
Evitare compressione aorto-cavale (decubito
laterale sinistro)
Uebing A et al. BMJ 2006;332: 401
39. Favorire l’insorgenza spontanea del travaglio ed il parto
vaginale in presenza di stabilità emodinamica.
Indicazioni per il taglio cesareo
- travaglio pre-termine in pazienti in TAO
- S. Marfan ed altri quadri di aneurisma ascendente
dell’aorta (IIaC se >45 mm, IIbC se 40-45 mm)
- dissecazione aortica (IIaC)
- stenosi aortica severa (IIaC)
- S. Eisenmenger (IIaC)
European Heart Journal 2011
40. La somministrazione di corticosteroidi alla madre quando
vi è la necessità di indurre il parto prima delle 35
settimane riduce significativamente il rischio di
mortalità perinatale.
Il taglio cesareo fuori travaglio in una gravidanza in
normale evoluzione aumenta il rischio di distress
respiratorio anche nella gravidanza presso il termine
(36 – 38 settimane).
41. APPROCCIO MULTIDISCIPLINARE
(cardiologo, ostetrico, internista, anestesista,
neonatologo)
Valutazione PRECONCEZIONALE
Riferire le pazienti a CENTRI ESPERTI
Follow-up cardiologico e ostetrico più INTENSO
in particolare dalla seconda metà della gravidanza
42.
Rivalutazione clinica e strumentale
(ECG, Rx Torace, Test ergometrico, Test Cardiopolmonare)
Rivalutazione della terapia farmacologica in
corso: necessità di modificazioni ?
Indicazione a correzione chirurgica o con
angioplastica percutanea prima di iniziare
la gestazione
Timing della gravidanza
46. pressione sistolica media pressione diastolica media
settimane di gestazione settimane di gestazione
PA più bassa in posizione supina – effetto cava
47.
48. Effetto della gravidanza sulla
cardiopatia
Effetto della cardiopatia sulla
gravidanza