Pregnancy with Heart Disease: Symptoms, Causes, And Treatment

Rheumatic heart disease:

Usually, mitral stenosis is common. Symptoms occur when stenosis narrows the valve to less than 2.5 cm2. There is a chance of pulmonary edema. 

Read: Is Rheumatic Fever Contagious? | Scarlet Fever vs Rheumatic Fever

Congenital heart disease:

These may be of cyanotic varieties like Atrial Septal Defect (ASD), ventricular septal defect (VSD), or and distorted red cells .

 These sickle-shaped cells block the microcirculation causing increased destruction, hemolysis, anemia, & jaundice. 

Rheumatic heart disease

Mitral Stenosis:

• Mitral stenosis is the most typical heart lesion met during pregnancy. Normal mitral valve area ranges between 4 and 6 cm2
• Symptoms usually appear when stenosis narrows this to less than 2.5 cm2. Women with mitral valve area <1 cm2 have a high rate of pulmonary edema (55%) and arrhythmia (33%).
• Diagnosis and management have been mentions earlier. During labor, continuous epidural analgesia is ideal, and intravenous fluid overload is to avoid.

Aortic Stenosis:

Common symptoms

• Angina 
• Syncopv, 
• Left ventricular failure. 

Suggested read: Angina Pectoris Occurs When….

Treatment–

• Valve replacement, 
• Aortic balloon valvuloplasty may stay fixed as a palliative surgery 

Congenital heart disease

Acyanotic 

Atrial Septal Defect (ASD):

Atrial Septal defect (ASD) is a hole in the wall between the two upper chambers of your heart. The condition is present at birth. ASD (ostium secundum type) is the most common congenital heart lesion during pregnancy. Even uncorrected ASD tolerates pregnancy and labor well. 

Congestive cardiac failure unresponsive to medical therapy requires surgical Correction.  Shunt reversal is a significant risk that may develop in hypovolemia. 

Patent Ductus Arteriosus (PDA):

The presence of continuous murmur at the upper left sternal border is suggestive of the diagnosis. 

Most patients with PDA tolerate pregnancy well. Pulmonary hypertension may cause maternal death. Surgical Correction during pregnancy can be performed provided there is no pulmonary hypertension. 

I also wrote a article on Portal Hypertension: Symptoms, Causes, Diagnosis, and Treatment also you can read.

Mitral Valve Prolapse (MVP):

Is the commonest congenital valvular lesion. Most of them are asymptomatic. Women tolerate pregnancy and labor well. Endocarditis prophylaxis is giving. 

Cyanotic 

Fallot’s tetra logy:

It is the most common form of cyanotic heart lesion. It is a combination of (a) Ventricular Septal defect, (b) pulmonary valve stenosis, (c) right ventricular hypertrophy, and (d) an overriding aorta. 

• After surgical Correction, patients tolerate pregnancy well. Surgically uncorrected patients are at increased risk. 
• Complications like bacterial endocarditic, brain abscess, and cerebral embolism are more common. 
• Maternal mortality is 5-10%, and prenatal mortality is 30-40%.  
• Systemic hypotension is dangerous, which may lead even to death. Epidural or spinal anesthesia avoids. Pregnancy is discouraged in women with uncorrected tetra logy

Other congenital heart lesions

Coarctation of the aorta:

• The maternal risks are hypertension, aortic dissection, bacterial endocarditic, and cerebral hemorrhage due to ruptured intracranial aneurysms. 
• Maternal mortality is high 3-9%. Fetal loss is also increasing to 25%. 
• Should do surgical Correction before pregnancy. 
• Termination of pregnancy should seriously be considering. 
• Elective cesarean section is preferred to minimize dissection associated with labor.

Cardiomyopathies

Peripartum cardiomyopathy:

Important diagnostic criteria are:

• Cardiac failure within the last month of pregnancy or five months postpartum. 
• No determinable cause for failure. 
• Absence of previous heart disease. 
• Left ventricular dysfunction as evidenced on echocardiography- 
• Ejection fraction less than 45%
• The patients are usually multiparous and young (20-35 years). They complain of weakness, shortness of breath, cough, nocturnal dyspnea, and pulse.

I have already covered:

• When To Go To The Hospital For Rapid Heart Rate?
• How To Treat Postpartum Depression? | Risk Factors For Postpartum Depression