Cardiovascular Complications during PREGNANCY

Posted by e-Medical PPT Saturday, July 10, 2010
Peripartum cardiomyopathy (PPCM). This is an unexplained left ventricular systolic dysfunction developing in the last month of pregnancy or within five months of delivery in previously healthy women. PPCM also sometimes affects women with preexisting heart disease and diminished cardiovascular reserve but whose LV function has previously been normal.In the West, there is an incidence of PPCM of between 1 in 10000 to 15000 pregnancies, but in developing countries it is seen more frequently.
The worst cases of Peripartum cardiomyopathy tend to develop during the first few days postpartum and women present with heart failure with marked fluid retention.Implantation of a device as a bridge to recovery is much preferable to transplantation. Less severe cases require standard therapy for heart failure, and their LV function should be monitored carefully. Anticoagulants are also important, as the risk of systemic embolism is high.
Women with hypertrophic cardiomyopathy are sometimes first diagnosed during pregnancy, which can cause considerable distress because of the genetic implications. These patients usually tolerate pregnancy well, although serious complicationssuch as Congestive Heart Failure, supraventricular tachycardia (SVT), ventricular tachycardia (VT), and syncope can occur. Beta blockers can be used, as in the nonpregnant state, and dual chamber pacing therapy may be of value in patients with symptoms refractory to medical therapy.
Ectopic beats and sustained arrhythmias become more frequent during pregnancy, when they may even develop for the first time. In general, these are treated in the same way as outside pregnancy but as conservatively as possible, reserving the definitive treatment for later if it is safe to do so. Digoxin and beta blockers are the antiarrhythmic drugs of choice during pregnancy, but quinidine, adenosine, sotalol, and lidocaine are also "safe,". Electrical cardioversion is also safe in pregnancy.

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