Heart diseases complicating pregnancy

Heart diseases complicating pregnancy

Prevalence of heart diseases is about 1%

Two types of heart diseases- Rheumatic Congenital

Rheumatic- Mitral stenosis (prominent in 90%)

Congenital- Atrial septal defect(ASD)

Echo cardiography useful investigation in pregnancy

Advantage no radiation exposure

ECG useful in diagnosing arrhythmias

Complications :

CONGESTIVE CARDIAC FAILURE

ACUTE PULMONARY OEDEMA

ARRHYTHMIAS

SUBACUTE BACTERIAL ENDOCARDITIS

CONGESTIVE CARDIAC FAILUREPrinciple same treatment as given in non-pregnant state

Digoxin to increase force of contraction - to decrease rate of contraction - also used in some women, not in failures but at high risk of atrial fibrillation ( severe mitral valve diseases)

Diuretics (frusemide) administered

ACUTE PULMONARY OEDEMACommon Tight Mitral stenosis

Symptoms- acute paroxysmal nocturnal dyspnoea - cough - haemoptysis - expectoration of frothy sputum

Diuresis indicated with Frusemide

Morphine and frusemide given intra venously

Aminophylline as an IV infusion

Indication for balloon valvuloplasty or closed mitral valvotomy in pregnancy :- life threatening pulmonary oedema not responding to medical management and recurrent episodes

ARRHYTHMIASVariation from normal rhythm or rate of heart beat

Anti-Arrhythmic drugs administered- Digoxin -Beta-blockers (Propranolol & Verapamil)

Digoxin- cardiotonic glycoside obtained from Digitalis lanata - consist of 3 sugars and digoxigenin -used to control ventricular rate in atrial fibrillation and for congestive cardiac failure with atrial fibrillation

Beta blockers :- to slow down heart rate

SUBACUTE BACTERIAL ENDOCARDITIS Common in mitral stenosis ( especially in those with prosthetic valves)

Common organism involved : Streptococcus viridans Streptococcus faecalis Staphylococcus aureusClinical features: fever haematuria haemoptysis Blood cultures necessary to start appropriate antibiotic therapy

Mortality around 30%

CARDIAC SURGERY IN PREGNANCYPreviously in mitral stenosis, Closed mitral valvotomy was done

Nowadays, Balloon valvuloplasty is done, if the valve is pliable and not calcified and regurgitation is minimal

Main disadvantage is Radiation exposure

Safest time to do any procedure is second trimester after 20 wks

In severe cases with non pliable valve, open heart surgery is done. But chance of fetal loss is very high

Maternal and fetal outcome in cardiac diseases Maternal outcome:- Low risk(mortality