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CVS Changes During Pregnancy. 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 2 nd , 3 rd trimester , 6 weeks & 6 months postpartum

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outcome in cardiac disease
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

outcome in cardiac disease3
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

vlavular disease in pregnancy
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

arrhythmia during pregnancy
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
peripartum cardiomyopathy11
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

peripartum cardiomyopathy12
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