Heart Disease in Pregnancy

Chapter 51


Heart Disease in Pregnancy





1. What cardiac physiologic changes occur during pregnancy?


    Hormonal changes cause an increase in both plasma volume (from water and sodium retention) and red blood cell volume (from erythrocytosis) during a normal pregnancy. A disproportionate increase in plasma volume explains the physiologic anemia of pregnancy. Maternal heart rate (HR) increases throughout the 40 weeks, mediated partially by increased sympathetic tone and heat production. Stroke volume subsequently continues to increase until the third trimester, when inferior vena cava (IVC) return may be compromised by the gravid uterus. Maternal cardiac output increases by 30% to 50% during a normal pregnancy. Systolic blood pressure drops during the first half of pregnancy and returns to normal levels by delivery. The physiologic changes related to cardiac output that occur during pregnancy are shown in Figure 51-1.



2. Are there independent vascular changes that occur during a normal pregnancy?


    The vascular wall weakens during pregnancy as a result of estrogen and prostaglandin, leading to increased risk for vascular dissection. As the placenta develops, it creates a low-resistance circulation. These factors, in addition to heat production, contribute to the reduced systemic vascular resistance (SVR) that is a normal part of pregnancy.


3. What are normal cardiac signs and symptoms of pregnancy?



4. What are pathologic cardiac signs and symptoms of pregnancy?



5. What are normal cardiac examination findings during pregnancy?



6. What are pathologic cardiac exam findings during pregnancy?



image Clubbing and cyanosis are not a part of normal pregnancy; desaturation for any reason is abnormal and warrants investigation.


image Elevated jugular venous pressure (JVP) is abnormal, reflecting elevated right atrial pressure. Although edema is common in this population, it is important to evaluate neck veins in any pregnant woman with peripheral edema.


image Pulmonary hypertension (right ventricular heave, loud P2, JVP elevation) findings should be investigated early. Women with preexisting pulmonary hypertension (pulmonary pressure greater than 75% of systemic pressure) should be counseled prior to pregnancy as to the risks.


image Systolic murmur 3/6 or louder and any diastolic murmur audible in pregnancy are considered abnormal and warrant evaluation.


image Audible S4 is unusual during pregnancy and may reflect underlying hypertension.


7. What are the cardiac changes that occur during labor and delivery?

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Jun 5, 2016 | Posted by in CARDIOLOGY | Comments Off on Heart Disease in Pregnancy

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