Heart disease in pregnancy

Bhumika

Improvised by
Dr Akanksha ma’am
Dr Shweta ma’am

Guided by
Dr Shehla Ma’am
History of heart disease in
Pregnancy
 Current or past evidence of heart lesion
 Dyspnea at rest
 Paroxysmal nocturnal dyspnea
 Orthopnea
 Haemoptysis
 Prophylaxis with long acting penicillin
 Rheumatic fever
 Examination of heart disease in pregnancy

 Examination may reveal

• Murmur-systolic
• Accentuated heart sound
• Central cyanosis
• Displaced apex beat
• Manifestations of left side heart failure might be - gallop rhythm
- crepitations over lung bases
- pleural effusion
• Manifestations of right side heart failure might be :-
• congested neck veins
• Enlarged tender liver
• Ascites
• Oedema in lower limb
The clinical features in a normal pregnancy which
can mimic a cardiac disease
 Dyspnea- due to hyperventilation and elevated diaphragm
 Pedal oedema
 Cardiac impulse- diffused and shifted laterally due to
elevated diaphragm
 Jugular veins may be distended
 Rise in jugular venous pressure
Clinical features
 Signs and symptoms:-
1) Mitral stenosis - easy fatiguability, shortness of breath ,orthopnea,
pulmonary congestion
2) Right sided heart failure – weight gain ,dependent
oedema ,hepatomegaly ,increase jugular venous pressure, bi-
ventricular failure, pedal edema, rarely ascitis
3) Left side heart failure-bronchospasm after few hours of sleep
(paroxysmal nocturnal Dyspnea), tachycardia, shortness of
breath( MC)
Clinical features
4) Pulmonary venous hypertension - signs same as mitral stenosis
5)chest pain
6) Palpitations
7)Syncope
8)Cardiomegaly
9)Displacement of apex beat
10)Nocturnal cough
 Diagnosis of cardiac disease
 Full cardiovascular examination including personal history and
assessment of lifestyle risk factors
 Blood tests- CBC ,clotting factors and cardiac enzymes (troponin)
 ECG
 Chestradiography(using lead shield):- cardiomegaly , enlargement of
pulmonary vein
Echocardiography :-
otrans thoracic:- to determine ventricular function
oTrans oesophageal :-imaging of valvular disease , suspect
infective endocarditis
oFoetal :-for foetal heart obtained by 20 weeks gestation
Diagnosis

 CT Scan
 MRI
 Colour flow doppler study :-
structural abnormalities, valve anatomy , valve area,
pulmonary artery systolic pressure
Prognosis
 Prognosis depending on the functional status
o In general women in NYHA classes I and II lesions
usually so well during pregnancy and have a
favourable prognosis with a mortality rate of <1%.
o Patients in NYHA classes III and IV may have a
mortality rate of 5% to 15% .
Maternal prognosis
 Depends on:-
 nature of the lesion
 functional capacity of the lungs
 qualityof medical supervision provided during
pregnancy/labour/puerperium
 presence of other risk factors
 Maternal mortality less in rheumatic heart lesion and
acynotic group of heart disease (ASD,VSD,Pulmonary
stenosis, AS)
Maternal prognosis
 Maternal mortality increases in cyanotic heart disease if there is
increase in vascular resistance
 50% (eisenmenger’s syndrome )
 Most death occur due to cardiac failure following birth
 Other causes of death :- pulmonary oedema
pulmonary embolism
Subacute bacterial endocarditis
Fetal prognosis

 In rheumatic heart disease:– fetal outcome is good

 Cyanotic group of disease ;- increases fetal loss (45%) due to
abortion, IUGR, prematurity

 Fetal congenital cardiac disease is increased by 3-10% if either of

parent have congenital disease.