Cardiac disease in pregnancy and hypertrophic cardiomyopathy

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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

Special Scenarios:

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(s)-In-Chief: Anjan K. Chakrabarti, M.D. [2]

Overview

Patients with pre-existing cardiomyopathies such as dilated cardiomyopathy and hypertrophic cardiomyopathy, 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.

Pathophysiology

Hypertrophic cardiomyopathy (HCM) is an autosomal dominant disease due to mutations of the cardiac sarcomere proteins, which result in asymmetric hypertrophy of the left ventricle, a nondilated left ventricular cavity, and preserved systolic function with impaired diastolic function.[1]

Left ventricular outflow tract obstruction (LVOT) is present at rest in approximately 20% of patients.[2]

Natural History, Complications and Prognosis

Although most women with HCM with minimal or mild symptoms tolerate pregnancy well, the risks associated with pregnancy include:[3]

  • Sudden death, particularly in patients with severe outflow obstruction or other risk factors for sudden cardiac death.
  • Hemodynamic deterioration, particularly in those with moderate or severe symptoms before pregnancy.

Treatment

Medical Therapy

Management considerations during pregnancy, labor, and delivery include:[3]

Related Chapter

References

  1. Autore C, Conte MR, Piccininno M, Bernabò P, Bonfiglio G, Bruzzi P; et al. (2002). "Risk associated with pregnancy in hypertrophic cardiomyopathy". J Am Coll Cardiol. 40 (10): 1864–9. PMID 12446072.
  2. Spirito P, Autore C (2006). "Management of hypertrophic cardiomyopathy". BMJ. 332 (7552): 1251–5. doi:10.1136/bmj.332.7552.1251. PMC 1471918. PMID 16735335.
  3. 3.0 3.1 Stergiopoulos K, Shiang E, Bench T (2011). "Pregnancy in patients with pre-existing cardiomyopathies". J Am Coll Cardiol. 58 (4): 337–50. doi:10.1016/j.jacc.2011.04.014. PMID 21757110.


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