Approach to cardiac diseases in pregnancy

Approach to Cardiac Disease in Pregnancy Mehul Bhatt, MD Athens Heart Center March 13, 2009

Approach to Cardiac Disease in Pregnancy Physiological changes in pregnancy Systematic approach to cardiac lesions Principal of monitoring and treatment Individualizing treatment to each patient

Normal Physiological Changes in Pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Normal Physiological Changes in Pregnancy Braunwald E et al. Heart Disease. 2001. pg. 2173.

Normal Physiological Changes in Pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Normal Physiological Changes in Pregnancy Braunwald E et al. Heart Disease. 2001. pg. 2172.

Normal Physiological Changes in Pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Normal Physiological Changes in Pregnancy ,[object Object],[object Object],[object Object],Cutforth R et al. Heart sounds and mumurs in pregnancy. Am Heart J. 1966;71:741-747.

Normal Physiological Changes in Pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Elkayam U et al. Cardiac Problems in Pregnancy. 1990.34-7.

Normal Physiological Changes in Pregnancy ,[object Object],[object Object],Braunwald E et al. Heart Disease. 2001. pg. 2172.

Normal Physiological Changes in Pregnancy ,[object Object],[object Object],[object Object],[object Object],Elkayam U et al. Cardiac Problems in Pregnancy. 1990. 16. Parameter Change Comments Blood Volume Increase 300-500 mL Cardiac Output Increase 30-60% increase Heart Rate Increase or Decrease Blood Pressure Increase SBP and DBP Peripheral Resistance Unchanged O 2 Consumption Increase 100% increase

Normal Physiological Changes in Pregnancy ,[object Object],[object Object],[object Object]

Normal Physiological Changes in Pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object]

Normal Physiological Changes in Pregnancy Hemodynamic Changes Postpartum Parameter Change Comment Blood Volume Decrease Blood loss CO Increase 60-80% immediate increase followed by rapid decrease, returns to normal levels in few weeks SV Increase HR Decrease BP Unchanged SVR Increase Loss of low resistance placenta

Cardiac Diseases in Pregnancy: Basics ,[object Object],[object Object],[object Object]

Cardiac Disease in Pregnancy: Basics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cardiac Disease in Pregnancy: Congenital Heart Disease ,[object Object],Lesions with volume overload Lesions with obstruction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cardiac Disease in Pregnancy: Cardiac Lesions Pregnancy well tolerated (except if progress to Eisenmenger’s syndrome) (able to tolerate increased volume) Pregnancy poorly tolerated ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cardiac Disease in Pregnancy: Cardiac Lesions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cardiac Disease in Pregnancy: Monitoring and Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cardiac Disease in Pregnancy: Monitoring and Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cardiac Disease in Pregnancy: Monitoring and Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cardiac Disease in Pregnancy: Monitoring and Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cardiac Disease in Pregnancy: Highest-Risk Cardiac Lesions ,[object Object],[object Object],[object Object]

Cardiac Disease in Pregnancy: Peripartum Cardiomyopathy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cardiac Disease in Pregnancy: Acute Myocardial Infarction ,[object Object],[object Object],[object Object],[object Object],[object Object]

Cardiac Disease in Pregnancy: Anticoagulation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cardiac Disease in Pregnancy: Anticoagulation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cardiac Disease in Pregnancy: Prosthetic Valves ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cardiac Disease in Pregnancy: Prosthetic Valves Braunwald E et al. Heart Disease. 2001. pg. 2186.

Cardiac Disease in Pregnancy ,[object Object],[object Object],[object Object]

Approach to cardiac diseases in pregnancy

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Approach to cardiac diseases in pregnancy