A Woman With Cardiac Disease

Prepared by : Joanne Bernadette C. Aguilar

 A Woman with Cardiac Disease

 Cardiac disease can affect pregnancy in different ways depending on

whether it involves the left or the right side of the heart.
 Cardiac disease in the pregnant patient can present challenges in
cardiovascular and maternal-fetal management. It is important to
understand that even in normal patients, pregnancy imposes some
dramatic physiological changes upon the cardiovascular system.
These include:
 1. Increase in plasma volume by 50%
 2. Increase in resting pulse by 17%
 3. Increase in cardiac output by 50%.
 A Woman With Left-Sided Heart Failure
 Left-sided heart failure occurs in conditions such as mitral stenosis, mitral insufficiency and aortic
coarctation. Extremely high risk for spontaneous miscarriage, preterm labor and death.

 Mitral stenosis - Mitral stenosis means that when the mitral valve opens, it does not open fully. The
opening is therefore narrower than normal (stenosed). So, there is some restriction of blood flow
from the left atrium to the left ventricle. This in turn means there is a reduced amount of blood that is
pumped out into the body from the left ventricle. In general, the more narrowed the valve, the less
blood can get through and the more severe the problem is likely to be.

 Mitral insufficiency - Mitral regurgitation (MR), Mitral insufficiency (abbreviation MI best avoided
because it is more commonly used in lieu of myocardial infarction), or mitral incompetence is a
disorder of the heart in which the mitral valve does not close properly when the heart pumps out
blood. It is the abnormal leaking of blood backwards from the left ventricle, through the mitral valve,
into the left atrium, when the left ventricle contracts, there is regurgitation of blood back into the left
atrium. MR is the most common form of valvular heart disease.
 Aortic Coarctation - Coarctation of the aorta also called aortic narrowing,
whereby the aorta is narrow, usually in the area where the ductus
arteriosus (ligamentum arteriosum after regression) inserts. The word
"coarctation" means narrowing. Coarctations are most common in the
aortic arch. The arch may be small in babies with coarctations. Other
heart defects may also occur when coarctation is present, typically
occurring on the left side of the heart. When a patient has a coarctation,
the left ventricle has to work harder. Since the aorta is narrowed, the left
ventricle must generate a much higher pressure than normal in order to
force enough blood through the aorta to deliver blood to the lower part of
the body. If the narrowing is severe enough, the left ventricle may not be
strong enough to push blood through the coarctation, thus resulting in
lack of blood to the lower half of the body. Aortic coarctation and aortic
stenosis are both forms of aortic narrowing. In terms of word root
meanings, the names are not different, but a conventional distinction in
their usage allows differentiation of clinical aspects
 Signs and Symptoms:

Mitral Stenosis : Aortic Coarctation:

1. Increased fatigue 1. Fatigue and life threatening
intracranial hemorrhage
2. Weakness 2. Chest pain
3. Dizziness 3. Headaches

Mitral Insufficiency:
1. Orthopnea
2. Paroxysmal nocturnal dyspnea
3. Shortness of breath
4. Pulmonary edema
 Drug of Choice
 For Mitral stenosis: angiotensin-converting enzyme (ACE) inhibitors or renin-angiotensin
system, 'water tablets' (diuretics) and anticoagulation medication. If you develop atrial
fibrillation, several medicines can be used to slow the heart rate down.

 For Mitral insufficiency: angiotensin-converting enzyme (ACE) inhibitors, 'water tablets'

(diuretics) and anticoagulation medication. If you develop atrial fibrillation, several
medicines can be used to slow the heart rate down.

 For Aortic Coarctation:

 Prostaglandin E1 is used in neonates to open the ductus and achieve improved

haemodynamic stability when the patient presents acutely.

 Diuretics and inotropes are used to treat congestive cardiac failure affecting neonates and
adults alike.

 Beta-blockers are used to treat hypertension in adults before physical correction of the
coarctation, and may be used afterwards for persisting hypertension.

 Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II antagonists may be

used alongside beta-blockers to treat post-correction hypertension if the aortic arch
obstruction is eliminated.
 Anticoagulant – to prevent thrombus formation
 Antihypertensives – to decrease the strain of the aorta and to control blood
pressure
 Diuretics- to reduce blood volume
 Beta blockers- to improve ventricular filling
 If anticoagulant is required, low molecular weight heparin is the drug of choice
for early pregnancy
 Complications

 Hypertension
 Infective endocarditis
 Thrombus formation
 Recoarctation after repair.
 Impaired left ventricular systolic/diastolic function progressing to congestive
cardiac failure.
 Thoracic aortic aneurysm.
 Aortic dissection - high risk in pregnancy.
 Cerebral aneurysm rupture - high risk in pregnancy.