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CVS Changes During Pregnancy

CVS Changes During Pregnancy

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CVS Changes During Pregnancy

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  1. CVS Changes During Pregnancy

  2. Outcome in Cardiac Disease • CARPERG study multi-center prospective study across Canada (1994-1999) • 599 pregnancies with established cardiac disease before pregnancy referred to cardiology • followed at 2nd, 3rd trimester , 6 weeks & 6 months postpartum • Incidence of cardiac complication • pulmonary edema, symptomatic arrhythmias, • stroke ,cardiac arrest & cardiac death Circulation 2001

  3. Outcome in Cardiac Disease • Cardiac event occurred in 13 % (80/599) • 55% occurred in the prepartum period. • Pulmonary edema and cardiac arrhythmia accounted for most of the cardiac events • Embolic strokes occurred during 4 pregnancies  dilated CM, mitral stenosis mechanical valve with suboptimal anticoagulation Circulation 2001

  4. Vlavular Disease In Pregnancy • Presents usually with arrhythmia or CHF • Stenosis (mitral or aortic) is less tolerated than regurgitation • Increased risk of cardio embolism • Few case report of balloon valvuloplasty Elkayam JACC 2005

  5. Anticoagulation For Mechanical Valve

  6. Arrhythmia During Pregnancy • Common gestational changes Increased HR  short PR & QT interval Lt axis with non specific ST changes • Symptomatic arrhythmia is usually a manifestation of structural heart disease • All anti-arrhythmic Rx are class C , may need dose adjustment

  7. Peripartum Cardiomyopathy

  8. Peripartum Cardiomyopathy • Rare 1 in 13,000-15,000 • High mortality 8% • Half of the mortality occur in first 6 weeks postpartum& other half within a year  HF , arrhythmia or thromboembolism • Cause unknown ? Viral Vs Autoimmune Abboud Int.Jr.Cardiology 2007

  9. Peripartum Cardiomyopathy • Risk factor : advanced age , multiparity multiple gestation , preeclampsia , HTN • Rx : diuretic , after load reduction +/- inotropes Abboud Int.Jr.Cardiology 2007 • Limited contractile function in asymptomatic patients with normal resting Echo upon dobutamine challenge Lampert Am Jr Obst & Gyne 1997