Physiological Changes

• Peripheral
resistance
• Pulmonary
resistance
• Colloid oncotic
pressure
• Cardiac output
• Pulse rate
Risk
 Symptomps
• Fatigue
• Dyspnea
• Orthopnea
• Pulmonary congestion
NYHA Classification
 Fatal Events
•Heart failure 
Cardiogenic Shock
•Arrhythmia
•Pulmonary Edema 
Respiratory Failure
 Milestone of Cardiac Disease
Weeks of Pregnancy Event Related to Heart
Gestational Disease
Age
12-16 Hemodynamic changes on Pregnancy

28-32 50% will almost develop into NYHA Class II-III

Labour and 300-500 cc blood injected into blood vessels during

Delivery contraction
V. Cava compression will decrease cardiac filling
Labour and Delivery
 Acute CHF in Pregnancy
• Reduce cardiac work  bed rest
• Decrease pre-load  diuretics
• Improve contractility
• Reduce after-load  vasodilators
 Pulmonary Edema
• Mobilization of fluid from interstitial space to
alveolar space
• Desaturation
• Retention of CO2
• Preeclampsia  endothelial injury  increase
of permeability
 Mitral Stenosis
• Left atrium  left
ventricle
• May develop
pulmonary edema
• Reduce preload
 Aortic Stenosis
• Decrease blood flow
• Angina or syncope
• Not to adequate
hydration 125-
150cc/hour
 Pulmonic Stenosis
• May tolerable during
pregnancy
 Mitral Valve Prolapse
• Arrhythmia and
Palpitation
• Propanolol
 Peripartum Cardiomyopathy
• Development of heart failure in the last month of
pregnancy or up to 5 months postpartum
• Absence of an identifiable cause for the cardiac
failure
• Absence of recognizable heart disease before the
last month of pregnancy
• Left ventricular dysfunction demonstrated by
echocardiographic criteria
 Peripartum Cardiomyopathy
• Ejection fraction less than 45% or M-mode
fractional shortening less than 30% or both
• End-diastolic dimension more than 2.7 cm/m2
 Peripartum Cardiomyopathy
• 20-35 yo
• 2nd or 3rd post partum month
• Bed rest, digitalis, diuretics, anticoagulant
• Recurrence 21%
• Women with persistent ventricular
dysfunction  AVOID PREGNANCY