AtoZ Diseases

What is this Condition?

Cardiovascular disease ranks fourth (after infection, toxemia, and hemorrhage) among the leading causes of maternal death. The physiologic stress of pregnancy and delivery is often more than a compromised heart can tolerate and often leads to death of the mother and child.

Approximately 1 % to 2% of pregnant women have heart disease, but the incidence is rising because current medical treatment allows more women with rheumatic heart disease or congenital defects to reach childbearing age. With careful management, the prognosis for pregnant women with cardiovascular disease is good. Decompensation (the heart’s failure to maintain adequate circulation) is the leading cause of maternal death. Infant mortality increases with decompensation, because uterine congestion, insufficient oxygenation, and the elevated carbon dioxide content of the blood not only endanger the fetus, but also frequently cause premature labor and delivery.

What causes it?

More than 80% of pregnant women who develop cardiovascular complications have a history of rheumatic heart disease. In the rest, these complications stem from congenital defects (10% to 15%) or coronary artery disease (2%).

The diseased heart is sometimes unable to meet the normal increased demands of pregnancy, which include a 25% increase in cardiac output (the amount of blood pumped by the heart per minute), a 40% to 50% increase in plasma volume, increased oxygen requirements, retention of salt and water, weight gain, and alterations in hemodynamics during delivery. This physiologic stress often leads to decompensation. The degree of decompensation depends on the woman’s age, the duration of heart disease, and the functional capacity of her heart at the outset of pregnancy.

What are its Symptoms?

The woman with cardiovascular disease during pregnancy will have distended neck veins, diastolic murmurs, moist crackles heard at the base of the lungs, an enlarged heart, and irregular heartbeats. Other typical symptoms may include bluish skin discoloration, pericardial friction rub, and pulse irregularities.

Decompensation may develop suddenly or gradually. As it progresses, the woman may experience swelling, increasing shortness of breath on exertion, palpitations, a smothering sensation, and coughing up blood.

How is it Diagnosed?

Exam findings, including unusual heart sounds, irregular heartbeats, and an enlarged heart, suggest cardiovascular disease. To determine the extent and cause of the disease, an electrocardiogram, echocardiogram, or phonocardiogram may be performed. X-rays show heart enlargement and congestion in the lungs. Cardiac catheterization should be postponed until after delivery, unless surgery is necessary.

How is it Treated?

The goal of therapy is to prevent complications and minimize the strain on the mother’s heart, primarily through rest. This may require periodic hospitalization for women with moderate heart dysfunction or with symptoms of decompensation, toxemia, or infection. Older women or those with previous episodes of decompensation may require hospitalization and bed rest throughout the pregnancy.

Drug therapy, when necessary, will use the safest possible drugs in the lowest possible dosages to minimize harm to the fetus. Diuretics and drugs that increase blood pressure, blood volume, or cardiac output should be used with extreme caution. If an anticoagulant is needed, heparin is the drug of choice. Digoxin (also known as Lanoxin) and common antiarrhythmics, such as Cardioquin and Procan SR, are often required. The preventive use of antibiotics is reserved for women who are susceptible to endocarditis.

A therapeutic abortion may be considered for women with severe heart dysfunction, especially if decompensation occurs during the first trimester. Women hospitalized with heart failure usually follow a regimen of digoxin, oxygen, rest, sedation, diuretics, and restricted intake of sodium and fluids. If these measures fail to improve symptoms, heart surgery may be necessary. During labor, the woman may require oxygen and an analgesic for relief of pain and apprehension without adversely affecting the fetus or herself. Depending on which procedure would be less stressful for the woman’s heart, delivery may be vaginal or by cesarean section.

Bed rest and medications already instituted should continue for at least 1 week after delivery because of a high incidence of decompensation, cardiovascular collapse, and maternal death during the early puerperal period.

Breast-feeding is undesirable for women with severe cardiovascular disease because it increases fluid and metabolic demands on the heart.

What can a Pregnant Woman with Cardiovascular Disease do?

Get plenty of rest and control your weight to decrease the strain on your heart. To prevent vascular congestion, limit your fluid and sodium intake. Take supplementary folic acid and iron to prevent anemia.

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