The document discusses various cardiovascular conditions and risks during pregnancy. It provides guidance on: 1) Conducting pre-pregnancy risk assessments for conditions like DVT, cardiomyopathy, and congenital heart disease. 2) Managing risks of thromboembolism which increase during pregnancy. Low molecular weight heparin or compression stockings can help. 3) Administering low-dose aspirin before 16 weeks to reduce preeclampsia risk, especially for those with multiple risk factors. 4) Evaluating dyspnea with BNP and echocardiography to identify valve lesions or heart failure. 5) Exercising caution but not prohibiting pregnancy for conditions like CAD, with stress ech

1. Pregnancy and
Heart diseases
 Dr.Safoin Kadi
 Consultant cardiologist at Al-Hayat medical center.
 D.I.S. Cardiovascular diseases.
 D.U. Echocardiography.
 D.U.Vascular echodoppler.
 D.U. Congenital and pediatric cardiology.

9. PRE-PREGNANCY RISK ASSESSMENT

11. Many disorders can be identified by taking a careful personal and
family history, particularly D.V.T , cardiomyopathies, the Marfan syndrome, congenital
heart disease, juvenile sudden death, long
QT syndrome, and catecholaminergic ventricular tachycardia
(VT) or Brugada syndrome.
It is important to ask specifically about possible sudden deaths in the family.
The assessment of dyspnoea is important for diagnosis and prognosis of valve
lesions and for heart failure.
A thorough physical examination , including auscultation for new murmurs, changes
in murmurs, and looking for signs of heart failure.
When dyspnoea occurs during pregnancy or when a new pathological murmer is heard,
echocardiography is indicated.
It is crucial to measure the BP, in left lateral recumbency using a standardized method,
and to look for proteinuria.

21. Graduated compression stockings

22. COMPRESSION STOCKING
PRESCRIPTION
1-SIZE
2-PRESSURE
3-LEVEL

23. VARICES
 30-40% OF PREGNANTWOMEN .
 We have to determine the type the severity
and the need for treatment or preventive
measures for each one of them.

24. Pregnancy induces a series of haemostatic changes, with
an increase in concentration of coagulation factors,
fibrinogen, and platelet adhesiveness, as well as
diminished fibrinolysis, which lead
to hypercoagulability and an increased risk of
thrombo-embolic events.
In addition, obstruction to venous return
by the enlarging uterus causes stasis and a further rise in
risk of thrombo-embolism.
THROMBO EMBOLIC RISK

28. Take home message 1
 CONSIDER
LMWH OR
COPRESSIVE
STOCKING

29. Hypertension

37. women with a history of preeclampsia should receive
low-dose aspirin started before 16 weeks,
NICE guidelines say it should be started around 12
weeks.
That is the first point and the most important one.
The dosage should be at least 75 mg, and if possible,
we should probably try to evaluate aspirin resistance.
 the effect of aspirin before conception: Most
experts believe that it is not effective

38. NICE recommends : Aspirin 75 mg be
given to women with 2 or more of these
risk factors:
- First pregnancy
-Age older than 40 years
- Pregnancy interval greater than 10
years
-Body mass index (BMI) 35 kg/m2 or
greater at first visit,
-Family history of preeclampsia, or
-Multiple pregnancy.
Before 16 weeks of pregnancy

39. Placentation :is typically completed by 20-22
weeks at the latest.That means that women
could potentially take aspirin only for about 10
weeks, but no study has evaluated stopping
aspirin as early as that.
Some authors and experts have concluded
from many trials that aspirin should be
continued up to delivery, but if we use
dosages greater than 100 mg, women should
certainly stop aspirin therapy earlier. Others
have proposed, and I agree, that we should
probably stop aspirin around 34
weeks until new studies have evaluated the
effect of stopping aspirin therapy earlier or
later than that.

43. TAKE HOME MESSAGE 2
ASSESSEMENTOF RISK OF PREECLAMPSIA FOR EVERY PATIENT
IF MORETHAN 2 RISK FACTORS GIVEASPIRIN
BEGIN BEFOR 16WEEKSOF PREGNANCY (NOT BEFOR PREGNANCY)
STOPATWEEK 34

44. DYSPNEA

50. TAKE HOME MESSAGE 3
DYSPNEAASSESSEMENT IS FOLLOWED BY BNPAND
ECHOCARDIOGRAPHY.

60. TAKE HOME MESSAGE 4
VALVULAR HEART DISEASES HAVE AWIDE RANGE OF RISKWHICH
SHOULD BE EVALUATED BEFOR PREGNANCY .
TEAMWORK IS ESSENTIAL WITHTHE CARDIOLOGIST.
WARFARINE CAN BE GIVEN INTHE FIRSTTRIMESTER IF DOSE IS LESS
THAN 5 MG AND INTHE SECOND ANDTHIRDTRIMESTRE IN ANY DOSE.

64. The heart is rotated towards the left and on the
surface ECG there is a 15–20 left axis deviation.
Common findings include transient ST segment andT wave changes, the
presence of a Q wave and invertedT waves in lead III, an attenuated Q
wave in lead AVF, and invertedT waves in leadsV1,V2, and,
occasionally,V3. ECG changes can be related to a gradual change in the
position of the heart and may mimic left ventricular (LV) hypertrophy and
other structural heart diseases.

65. Performing sub maximal exercise
tests to reach 80% of predicted maximal heart rate
in asymptomatic pregnant patients with suspected
CVD.There is no evidence that it increases the risk of
spontaneous abortion.
Semirecumbent cycle ergometry appears to
be the most comfortable modality

66. TAKE HOME MESSAGE 5
CAD IS NOT AN ABSOLUTECONTRAINDICATION FOR PREGNANCY .
EXERCISETEST AND STRESS ECHOCARDIOGRAPHY CAN BE DONE
SAFELY.
INCASE OF ACUTE CORONARY EVENTANGIOPLASTY ISTHE
PREFFERRED METHOD OF REVASCULARISATION.

70. In general, caesarean delivery is reserved for
obstetric indications.
TAKE HOME MESSAGE 6

72.  Holter monitoring should be performed in patients with
known :previous paroxysmal or persistent documented
arrhythmia [VT, atrial fibrillation (AF), or atrial flutter or
those reporting symptoms of palpitations.

76. TAKE HOME MESSAGE 6
MOST PALPITATIONSARE BENIGNE BUT HOLTER MONITORING MAY
DETECT SERIOUSARRYTHMIA ESPECIALYWITHTHE PRESENCEOF A
MURMUR ,DYSPNEA,OR RISK FACTORS.