Heart Disease In Pregnancy Amal El Sayed

Cardiac Diseases in Pregnancy are Classified into: Mitral Valve Prolapse: Rheumatic heart diseases Congenital heart diseases Cardiac arrhythmias Peripartum cardiomyopathy

New York Heart Association’s Functional Classification of Heart Disease Class I: No sign or symptoms of cardiac decompensation Class II: No symptoms at rest but minor limitation of physical activity Class III: No symptoms at rest but marked limitation with physical activity Class IV: Symptoms at rest, discomfort increases with any kind of physical activity

Rheumatic Heart Disease Most common Heart disease in pregnancy Most common lesion is mitral stenosis The condition deteriorates with pregnancy due to the increase in cardiac output. Asymptomatic patients may suffer from heart failure or pulmonary edema Atrial Fibrillation and thromboembolic disease may happen Other complications include subacute bacterial endocarditis Antibiotic prophylaxis is essential. Penicillin is the drug of choice

Congenital Heart Disease Atrial Septal Defects Ventricular septal defects Primary pulmonary hyper tension Transposition of the great vessels If surgically corrected in childhood, patients do well. If not, decompensation may happen in pregnancy with increase maternal mortality during pregnancy and post partum.

Cardiac Arrythmias Supraventricular tachycardia is the most common. Usually associated with cardiac structural defects.

Peripartum Cardio Myopathy Rare No pre-exisiting cardiac lesions Occurs only in pregnancy Occurs with preeclampsia and HTN Dilation of heart chambers with heart failure High mortality (at least 20%) If patient survives, condition may recurre.

Managemnt Class I, II: Small risk Class III, IV: Big risk All cardiac patients should be managed by a cardiologist ECG Echo Avoid excess weight gain Low-sodium diet to avoid edema Adequate rest to avoid stress Avoid anemia Anti Coagulation

Mode of Delivery Vaginal, unless there is obstetric indication But avoid pushing by using forceps or vacuum Watch for fluid overload post-delivery, as this may precipitate heart failure

Renal Disease in Pregnancy

Asymptomatic Bacteruria The presence of bacteria in urine without symptoms Should be treated aggressively in pregnancy to avoid the development of UTI UTI most common organism E coli. Common in pregnancy due to: Stasis of urine Relaxation of urinary tract due to progesterone effect

Pyelonephritis Common due to: Stasis of urine due to dilation and relaxation of urinary system Pressure of the uterus on the ureters (especially right side)

Clinical Picture Fever, chills Dysuria Frequency Loin pain Bacteria and pus in urine

Treatment IV hydration IV Antibiotics Analgesia The aim of treatment is to prevent septicemia and premature labor

Acute Chronic Glomerulonephritis Causes destruction of renal parenchyma Secondary to infection or autoimmune disorder

Clinical Picture Fever Loin pain Casts in the urine Edema Protein urea Renal conditions become worse in pregnancy May lead to HTN and preeclampsia eclampsia

Treatment of the cause, and follow-up with KFTs which include: Na, K, CL, Bu, N, Creatine and Creatine clearance

Renal Failure Acute: Usually secondary to hypovolemia Chronic: Long standing renal damage