Management Of Cardiac Disease In Pregnancy

MANAGEMENT OF CARDIAC DISEASE IN PREGNANCY. PRESENTED BY DR. ADDAH A.O.

INTRODUCTION Heart disease is uncommon in pregnancy. Cardio-respiratory adaptation well tolerated by healthy women. These changes pose a threat to those with hearth disease. Though uncommon, continues to be a major cause of maternal morbidity in both developed and developing countries. Prognosis for pregnancy is good, if well managed. Multidisciplinary approach.

Classification of cardiac disease and risk assesment. HIGH RISK – Eisenmenger’s complex, tetralogy of Fallot, Ebstein’s anomaly, transposition of the great vessels. Pulmonary hypertension, Ischaemic heart disease, heart failure. MODERATE RISK. Valvular stenosis, coarctation of the aorta, Hx of myocardial infarction, Marfan syndrome, mechanical prosthetic valve. Low RiskAcyanotic heart disease, mild- moderate valvular regurgitation, small VSD, Small ASD.

PRECOCEPTION EVALUATION Preconception counselling. Cardiac HX. Functional status. CVS Examination. Ventricular Reserve. Suspected Valvular or congenital heart disease- Doppler echocardiography. Pulmonary artery pressure. Arrythmia risk Pacemaker or defribilation function. Dental hygiene. ABSOLUTE CONTRAIDICATIONS TO PREGNANCYPulmonary hypertension, Eisenmenger syndrome, severe mitral stenosis, Pul. hyprtension + ASD, VSD, PDA, CYANOTIC HEART DISEASE, Marfan syndrome.

PRE- Existing Heart Disease. Evaluate prior diagnostic results + intervention. Evaluate current medications.

MANAGEMENT OF HEART DISEASE IN PREGNANCY. Detect subtle changes in maternal wellbeing – symptoms Dyspnoea at rest. Substantial palpitations at rest or with other symptoms. Orthopnoea Paroxysmal nocturnal dyspnoea Exertional syncope, angina Chest pain at rest.

CVS EXAMINATION Evidence of pulmonary hypertension. Cyanosis Jugular venous distension. Persistent rales Cardiomegaly Loud P2, wide split of S2 Loud systolic murmur Clubbing Peripheral oedema Increased fluid retention Bradyarrhythmia Tachyarrhythmia. Blood pressure Pulse rate + rhythm Jugular venous pressure Presence of basal crepitations. Ankle + sacral oedema

CVS DIAGNOSTIC TESTING DURING PREGNANCY. Resting ECG may change in normal pregnancy. If arrhythmia not detected on a 12 lead ECG do 24- 48 hr ECG. ECG stress test. Echocardiography. Cardiac catheterisation + angiograohy. MRI

FURTHER MANAGEMENT. Outpatient mgt in most cases as patients remain well. Advice patient to reduce physical activities. Look for risk factors that would precipitate heart failure. Advice against smoking’ Prophylactic antibiotic for dental work, PROM, Prosthetic heart valves Termination of pregnancy is not medically advised unless in conditions stated above. Deteriorating cardiac status- admit . Add anticoagulants in those with congenital heart disease.

TREATMENT OF HEART FAILURE IN PREGNANCY. Admit to hospital Confirm diagnosis. Drug therapy – Digoxin. Diuretic esp. if there is pulmonary oedema. Oxygen PRN. Rx dysrrhymias with B- blockade Correct anaemia if present. Nurse in cardiac position.

MANAGEMENT OF LABOUR/DELIVERY. Aim for vaginal delivery. Induction of labour indicated for only obstetric reasons. Low risk of heart failure if cardiac reserve is good. Adequate analgesia – epidural Control IV fluids. Avoid autocaval compression. Shorten 2ND stage labour. Avoid Ergometrine Avoid caesarian section in presence of heart failure. Oxygen should be readily available Avoid B- sympathomimetic drugs.

FAMILY PLANNING Avoid COC’s IUCD – give prophylactic antibiotics during insertion.