/ /

  • linkedin
  • Increase Font
  • Sharebar

    Cardiovascular disease in pregnancy: What ob/gyns need to know

     

    Considerations in the postpartum period: It is important to retain an index of suspicion for cardiac disease not only during pregnancy but also in the postpartum period. It is not uncommon for women to present after the customary 4– to 8-week postpartum period with new or worsening symptoms that may be representative of pregnancy-related cardiomyopathy (ie, peripartum cardiomyopathy). Peripartum cardiomyopathy is defined as left ventricular systolic dysfunction (with an ejection fraction <45%) that is diagnosed during the last month of pregnancy or within 5 months postpartum without any identifiable cause of heart failure.24 Other diagnostic echocardiographic findings include a left ventricular end-diastolic dimension >2.7 cm/m2 or fractional shortening of <30% by M-mode echocardiography.25 These women typically present with symptoms that are often dismissed. Delays in diagnosis and appropriate treatment may result in devastating consequences.3

    Summary

    Pregnancy mimics heart disease. Normal physiologic complaints of pregnancy overlap with cardiac-related symptoms. In order to improve outcomes in mothers with preexisting or newly diagnosed cardiac conditions, it is imperative for ob/gyns, primary care physicians, and emergency room physicians to keep cardiac disease in the differential diagnosis of any pregnant or postpartum woman who has delivered within the previous year. Presence of cardiac symptoms should prompt further testing, appropriate referrals, and follow up.

     

    References

    1. Simpson LL. Maternal Cardiac Disease: Update for the Clinician. Obstet Gynecol. 2012;119:345-359.

    2. Creanga AA, Berg CJ, Syberson C, Seed K, Bruce FC, Callaghan WM. Pregnancy-related mortality in the United States, 2006-2010. Obstet Gynecol. 2015;125(1):5-12.

    3. Hameed AB, Lawton ES, McCain CL, et al. Pregnancy-Related Cardiovascular Deaths in California: Beyond Peripartum Cardiomyopathy. Am J Obstet Gynecol. 2015; pii: S0002-9378(15)00457-3.

    4. Warnes CA, Williams RG, Bashore TM, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). J American College of Cardiology 2008;52:e1-121.

    5. Clark SL, Cotton DB, Lee W, et al. Central hemodynamic assessment of normal term pregnancy. Am J Obstet Gynecol. 1989;161:1439-1442.

    6. Mabie WC, DiSessa TG, Crocker LG, et al. A longitudinal study of cardiac output in normal human pregnancy. Am J Obstet Gynecol. 1994;170(3):849-856.

    7. Burn J, Brennan P, Little J, et al. Recurrence risks in offspring of adults with major heart defects: results from first cohort of British collaborative study. Lancet. 1998;351:311-316.

    8. Harris I. Pregnancy in patients with congenital heart disease. Prog Cardiovasc Dis. 2011;53:305-311.

    9. Lupton M, Oteng-Ntim E, Ayida G, Steer PJ. Cardiac disease in pregnancy. Curr Opin Obstet Gynecol. 2002;14(2):137-143.

    10. Drenthen W, Pieper PG, Roos-Hesselink JW, et. al. Outcome of pregnancy in women with congenital heart disease: a literature review. J Am Coll Cardiol 2007;49:2303-2311.

    11. Gelson E, Curry R, Gatzoulis MA, et. al. Effect of maternal heart disease on fetal growth. Obstet Gynecol. 2011;117:886-891.

    12. Siu SC, Colman JM, Sorensen S, et al. Adverse neonatal and cardiac outcomes are more common in pregnant women with cardiac disease. Circulation. 2002;105:2179-2184.

    13. Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: The Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011;32:3147-197.

    14. Nishimura RA, Otto CM, Bonow RO, et al. AHA/ACC 2014 guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(23):2440-2492.

    15. Siu SC, Sermer M, Colman JM, et. al. Prospective multicenter study of pregnancy outcomes in women with heart disease. Circulation. 2001;104:515.

    16. Drenthen W, Boersma E, Balci A, Moons P, Roos-Hesselink JW, Mulder BJ. Predictors of pregnancy complications in women with congenital heart disease. Eur Heart J. 2010;31:2124–2132.

    17.  Balci A, Sollie-Szarynska KM, van de Bijl AGL, et al. Prospective validation and assessment of cardiovascular and offspring risk models for pregnant women with congenital heart disease.

    18. Hameed AB, Chan K, Ghamsary M, Elkayam U. Longitudinal Changes in the B-Type Natriuretic Peptide Levels in Normal Pregnancy and Postpartum. Clinical Cardiology. 2009; e-publication.

    19. Tanous D, Siu SC, Mason J, et al. B-type natriuretic peptide in pregnant women with heart disease. Journal of the American College of Cardiology. 2010;56:1247-1253.

    20. Thorne S, MacGregor A, Nelson-Piercy C. Risks of contraception and pregnancy in heart disease. Heart. 2006;92:1520-1525.

    21. Tepper N, Curtis KM, Jamieson DJ, Marchbanks PA. Update to CDC’s U.S. medical eligibility criteria for contraceptive use, 2010: revised recommendations for the use of contraceptive methods during the postpartum period. Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep 2011;60:878–883. Available at: http://www.cdc.gov/mmwr/pdf/wk/ mm6026.pdf

    22. Antibiotic prophylaxis for infective endocarditis. ACOG Committee Opinion Number 421. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2008;112:1193–1194.

    23. Wilson W, Taubert K, Gerwitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007;116:1736–1754.

    24. Sliwa K, Hilfiker-Kleiner D, Petrie MC, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy. Eur journal of heart failure 2010;12:767-778.


    25. Bhattacharyya A, Basra SS, Sen P, Kar B. Peripartum cardiomyopathy: A review. Tex Heart Inst J. 2012;39(1):8–16. 

    Afshan B Hameed, MD, FACOG, FACC
    Dr Hameed is Professor of Clinical Obstetrics & Gynecology, Professor of Clinical Cardiology, Medical Director, Obstetrics, Director, ...
    Jonathan Steller, MD
    Dr Steller is a third-year resident in the Department of Obstetrics and Gynecology, University of California, Irvine.

    0 Comments

    You must be signed in to leave a comment. Registering is fast and free!

    All comments must follow the ModernMedicine Network community rules and terms of use, and will be moderated. ModernMedicine reserves the right to use the comments we receive, in whole or in part,in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

    • No comments available

    Poll

    Latest Tweets Follow