Cardiac disease in pregnancy and hypertrophic cardiomyopathy: Difference between revisions

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===[[Dilated Cardiomyopathy|Dilated Cardiomyopaty]]===
===[[Dilated Cardiomyopathy|Dilated Cardiomyopaty]]===


This section will primarily focus on dilated cardiomyopathy in pregnancy.  For a more detailed discussion of dilated cardiomyopathy, click [[Dilated Cardiomyopathy|here]].
This section will primarily focus on dilated cardiomyopathy (DCM) in pregnancy.  For a more detailed discussion of dilated cardiomyopathy, click [[Dilated Cardiomyopathy|here]].
 
Currently, DCM is responsible for "approximately 10,000 deaths and 46,000 hospital stays each year in the United States and is the most common indication for cardiac transplantation."<ref name="pmid1590237">{{cite journal| author=Manolio TA, Baughman KL, Rodeheffer R, Pearson TA, Bristow JD, Michels VV et al.| title=Prevalence and etiology of idiopathic dilated cardiomyopathy (summary of a National Heart, Lung, and Blood Institute workshop. | journal=Am J Cardiol | year= 1992 | volume= 69 | issue= 17 | pages= 1458-66 | pmid=1590237 | doi= | pmc= | url= }} </ref>  The cause often remains unknown, in up to 50% of cases.<ref name="pmid10760308">{{cite journal| author=Felker GM, Thompson RE, Hare JM, Hruban RH, Clemetson DE, Howard DL et al.| title=Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. | journal=N Engl J Med | year= 2000 | volume= 342 | issue= 15 | pages= 1077-84 | pmid=10760308 | doi=10.1056/NEJM200004133421502 | pmc= | url= }} </ref>
 
In general, women with dilated cardiomyopathy are advised to avoid pregnancy for the following reasons:
 
*Dilated cardiomyopathy has been associated with A-type lamin gene defects, which are associated with a high rate of heart failure and life-threatening arrhythmias, as predicted by NYHA functional class<ref name="pmid18926329">{{cite journal| author=Pasotti M, Klersy C, Pilotto A, Marziliano N, Rapezzi C, Serio A et al.| title=Long-term outcome and risk stratification in dilated cardiolaminopathies. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 15 | pages= 1250-60 | pmid=18926329 | doi=10.1016/j.jacc.2008.06.044 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18926329  }} </ref>
*The increase in intravascular volume and cardiac output during pregnancy leads to a greater risk for complications in women with dilated cardiomyopathy, especially in the 3rd trimester
*A history of cardiac events including previous episodes of heart failure, atrial fibrillation or atrial flutter, transient ischemic attack, or a history of cardiac events before pregnancy is predictive of negative pregnancy-related cardiac outcomes<ref name="pmid11994252">{{cite journal| author=Siu SC, Colman JM, Sorensen S, Smallhorn JF, Farine D, Amankwah KS et al.| title=Adverse neonatal and cardiac outcomes are more common in pregnant women with cardiac disease. | journal=Circulation | year= 2002 | volume= 105 | issue= 18 | pages= 2179-84 | pmid=11994252 | doi= | pmc= | url= }} </ref>
 
 


==References==
==References==

Revision as of 13:32, 21 October 2011

Cardiac disease in pregnancy Microchapters

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Overview

Pathophysiology

Epidemiology and Demographics

Risk Factors

Diagnosis

History and Symptoms

Physical Examination

Electrocardiogram

Exercise Testing

Radiation Exposure

Chest X Ray

Echocardiography

MRI

CT

Catheterization:

Pulmonary artery catheterization
Cardiac catheterization
Cardiac Ablation

Treatment

Cardiovascular Drugs in Pregnancy

Labor and delivery

Resuscitation in Late Pregnancy

Contraindications to pregnancy

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I. Pre-existing Cardiac Disease:
Congenital Heart Disease
Repaired Congenital Heart Disease
Pulmonary Hypertension
Rheumatic Heart Disease
Connective Tissue Disorders
II. Valvular Heart Disease:
Mitral Stenosis
Mitral Regurgitation
Aortic Insufficiency
Aortic Stenosis
Mechanical Prosthetic Valves
Tissue Prosthetic Valves
III. Cardiomyopathy:
Dilated Cardiomyopathy
Hypertrophic Cardiomyopathy
Peripartum Cardiomyopathy
IV. Cardiac diseases that may develop During Pregnancy:
Arrhythmias
Acute Myocardial Infarction
Hypertension

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Anjan K. Chakrabarti, M.D. [2]

Overview

Patients with pre-existing cardiomyopathies prior to pregnancy often have significant difficulty dealing with the physiologic and hemodynamic changes that occur during pregnancy, labor, and delivery. In addition to these patients, there is a subset of patients who will develop peripartum cardiomyopathy.

Pre-Existing Cardiomyopathies

Dilated Cardiomyopaty

This section will primarily focus on dilated cardiomyopathy (DCM) in pregnancy. For a more detailed discussion of dilated cardiomyopathy, click here.

Currently, DCM is responsible for "approximately 10,000 deaths and 46,000 hospital stays each year in the United States and is the most common indication for cardiac transplantation."[1] The cause often remains unknown, in up to 50% of cases.[2]

In general, women with dilated cardiomyopathy are advised to avoid pregnancy for the following reasons:

  • Dilated cardiomyopathy has been associated with A-type lamin gene defects, which are associated with a high rate of heart failure and life-threatening arrhythmias, as predicted by NYHA functional class[3]
  • The increase in intravascular volume and cardiac output during pregnancy leads to a greater risk for complications in women with dilated cardiomyopathy, especially in the 3rd trimester
  • A history of cardiac events including previous episodes of heart failure, atrial fibrillation or atrial flutter, transient ischemic attack, or a history of cardiac events before pregnancy is predictive of negative pregnancy-related cardiac outcomes[4]


References

  1. Manolio TA, Baughman KL, Rodeheffer R, Pearson TA, Bristow JD, Michels VV; et al. (1992). "Prevalence and etiology of idiopathic dilated cardiomyopathy (summary of a National Heart, Lung, and Blood Institute workshop". Am J Cardiol. 69 (17): 1458–66. PMID 1590237.
  2. Felker GM, Thompson RE, Hare JM, Hruban RH, Clemetson DE, Howard DL; et al. (2000). "Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy". N Engl J Med. 342 (15): 1077–84. doi:10.1056/NEJM200004133421502. PMID 10760308.
  3. Pasotti M, Klersy C, Pilotto A, Marziliano N, Rapezzi C, Serio A; et al. (2008). "Long-term outcome and risk stratification in dilated cardiolaminopathies". J Am Coll Cardiol. 52 (15): 1250–60. doi:10.1016/j.jacc.2008.06.044. PMID 18926329.
  4. Siu SC, Colman JM, Sorensen S, Smallhorn JF, Farine D, Amankwah KS; et al. (2002). "Adverse neonatal and cardiac outcomes are more common in pregnant women with cardiac disease". Circulation. 105 (18): 2179–84. PMID 11994252.


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