No abstract

Summary The treatment of heart failure in pregnant women is more difficult than in non‐pregnant women, and should always involve a multidisciplinary team approach. Knowledge required includes hemodynamic changes in pregnancy and the resultant effect on women with pre‐existing or pregnancy‐related cardiovascular disease, cardiovascular drugs in pregnancy, ethical issues and challenges regarding saving mother and baby. In addition, women having high risk cardiac lesions should be counselled strongly against pregnancy and followed up regularly. Pregnancy with heart failure is an important issue, demanding more comprehensive studies.

Available online xxx Keywords:Valvular heart disease Pregnancy Maternal mortality a b s t r a c t Pregnancy is associated with significant hemodynamic changes that can aggravate valvular heart disease and increase the risk of thrombo-embolic events. Risk during pregnancy is dependent on the valve lesion, its severity, maternal pre-pregnancy functional capacity and the degree of left ventricular systolic function. For stenotic lesions, maternal and fetal risk increases when mitral or aortic valve area is less than 1.5 cm 2 .Pregnancy is usually well tolerated in women with chronic left sided valve regurgitation without left ventricular dysfunction. In patients with heart valve prostheses, hemodynamic tolerance is generally good, the issue is with anticoagulation. Many women with valvular heart disease can be successfully managed throughout pregnancy, labor and delivery with conservative medical measures designed to optimize intravascular volume, systemic loading conditions, blood pressure and rhythm. High risk patients require multidisciplinary close follow-up, so that any deterioration in symptom can be detected early and managed in a timely way.

No abstract

The growing epidemic of coronary heart disease in Asian countries can be prevented and controlled by identification and management of potentially modifiable risk factors. This article provides a single centre statistics of major modifiable risk factors among Malaysian patients presenting with acute coronary syndrome (ACS) and gives a brief discussion on preventive strategies. A single centre, prospective, observational, cohort study model was used. The subjects were patients of 18 years old or above who were admitted to University Malaya Medical Centre (UMMC), Malaysia within January 2009 to December 2010 and recruited under national ACS registry. Among 1525 consecutive ACS patients, 93% had at least one modifiable risk factor and nearly 70% had three or more risk factors. Overall, the prevalence of risk factors in descending order were: hypertension (70%), smoking (47%), diabetes (43%), dyslipidaemia (23%) and Body Mass Index (BMI)>24 (17%). Majority of male patients were smokers (67%) and most of the females were hypertensives (77%). Hypertension was the strongest predictor of mortality among all ACS patients (odds ratio 2.42, 95% CI, (1.43-4.10)]. Identification and primordial prevention of these risk factors are mandatory for prevention of coronary heart disease in the population. JCMCTA 2014 ; 25 (1): 32-36