Cardiac disease in pregnancy and acute myocardial infarction: Difference between revisions

Jump to navigation Jump to search
(Created page with "{{Cardiac disease in pregnancy}} {{CMG}}; {{AOEIC}} {{CZ}} ==Overview== * First reported case in 1922 * Incidence ~1/10000 * Ages range 16-45 * Most common in 3rd trimes...")
 
Line 2: Line 2:
{{CMG}}; {{AOEIC}} {{CZ}}
{{CMG}}; {{AOEIC}} {{CZ}}


==Overview==
==Historical Perspective==
* First reported case in 1922    
* First reported case in 1922
 
==Epidemiology and Demographics==
* Incidence ~1/10000
* Incidence ~1/10000
* Ages range 16-45
* Ages range 16-45
* Most common in 3rd trimester women > 33 years of age
* Anterior wall most commonly involved
* Maternal mortality 21% (most at time of [[MI]] or within 2 weeks- usually with labor and delivery)
* Maternal mortality 21% (most at time of [[MI]] or within 2 weeks- usually with labor and delivery)
* Outcomes better if [[MI]] early in pregnancy
* Fetal deaths usually associated with maternal deaths
* Fetal deaths usually associated with maternal deaths



Revision as of 14:27, 17 April 2012

Cardiac disease in pregnancy Microchapters

Home

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

Cardiac disease in pregnancy and acute myocardial infarction On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Cardiac disease in pregnancy and acute myocardial infarction

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Cardiac disease in pregnancy and acute myocardial infarction

CDC on Cardiac disease in pregnancy and acute myocardial infarction

Cardiac disease in pregnancy and acute myocardial infarction in the news

Blogs on Cardiac disease in pregnancy and acute myocardial infarction

Directions to Hospitals Treating Cardiac disease in pregnancy

Risk calculators and risk factors for Cardiac disease in pregnancy and acute myocardial infarction

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Historical Perspective

  • First reported case in 1922

Epidemiology and Demographics

  • Incidence ~1/10000
  • Ages range 16-45
  • Maternal mortality 21% (most at time of MI or within 2 weeks- usually with labor and delivery)
  • Fetal deaths usually associated with maternal deaths

Pathophysiology

Caths in 54% of published cases:

  • CAD with or without thrombus 43% (58% in prepartum period)
  • Thrombus without CAD 21%
  • Normal coronaries 29% (75% in peripartum period MIs)
  • Coronary dissection 16% (33% in postpartum period)

Risk factors

Diagnosis

  • EKG and enzymes are the gold standard
  • 37% of patients undergoing elective C-section have EKG changes suggestive of MI or ischemia
  • Echocardiography to assess regional wall motion abnormalities can be useful
  • Nuclear imaging and diagnostic cath exposure to conceptus <0.01 Gy (0.05 Gy considered to be threshold value)

Pharmacotherapy

Check with pharmacist or Maternal Fetal Medicine Specialist before any drug administration

Drugs to be Avoided

  • Greatest experience in massive pulmonary embolism
  • Streptokinase does not cross placental membrane in animals, but Ab found in neonatal spinal cord fluid
  • Urokinase not teratogenic in mice/rats
  • Risk for maternal hemorrhage (1 case of placental abruption reported); increased risk when given at time of delivery
  • Delivery best delayed at least 2-3 weeks

References


Template:WikiDoc Sources