CE: Gestational Hypertension, Preeclampsia, and Peripartum Cardiomyopathy: A Clinical Review

Maheu‐Cadotte, Marc‐André; Pépin, Catherine; Lavallée, Andréane; Hupé, Catherine; Mailhot, Tanya; Duchaine, Caroline; Fontaine, Guillaume

doi:10.1097/01.naj.0000605352.84144.a2

Cited by 5 publications

(5 citation statements)

References 78 publications

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“…На одному кінці спектру переважає підвищений серцевий викид, який може бути зумовлений збільшенням ударного об'єму, або частоти серцевих скорочень, або обома цими чинниками [13]. На іншому кінці спектру переважає підвищений загальний периферичний опір, що може бути пов'язано з вазоконстрикцією або зменшенням кількості функціональних капілярів [14][15][16].…”

Section: вступunclassified

Characteristics of changes in fetal doppler blood flow parameters in women with gestational hypertension at different stages of pregnancy

Podolskyi,

Znak

2023

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Research objectives: to determine the resistance index, pulsatile index and systolic-diastolic ratio in the fetal middle cerebral artery, fetal aorta and umbilical artery in women with gestational hypertension (GH).Materials and methods. The main group included 50 pregnant women with GH, the control group included 50 healthy pregnant women. Blood pressure level and ultrasound dopplerometric indicators of fetal blood flow were determined at the 20th, 25th, 30th, 35th, and 40th weeks of pregnancy.Results. Changes in Doppler blood flow indicators in the umbilical artery in women of the main group were observed earlier than changes in these indicators in the fetal aorta, namely from the 30th week of pregnancy: the resistance index was 0.46 ± 0.08, the pulsatility index was 0.8 ± 0.23, the systolic-diastolic ratio was 2 ± 0.19, and in women of the control group these indicators were 0.69 ± 0.17, 1.46 ± 0.21 and 3 ± 0.33, respectively.At the 35th week of pregnancy, the trend towards a decrease in dopplerometric indicators of blood flow in the umbilical artery in women of the main group continued, the value of these indicators was: resistance index – 0.42 ± 0.09, pulsatility index – 0.68 ± 0.23, systolic diastolic ratio – 1.8 ± 0.16, and in women of the control group these indicators were 0.68 ± 0.13, 1.43 ± 0.11 and 2.94 ± 0.24, respectively.The lowest Doppler parameters of blood flow in the umbilical artery in women of the main group were at 40th week: resistance index – 0.37 ± 0.07, pulsatility index – 0.63 ± 0.21, systolic-diastolic ratio – 1.6 ± 0.13, and in women of the control group these indicators were 0.67 ± 0.11, 1.4 ± 0.1, and 2.87 ± 0.21, respectively.Conclusions. Blood flow indicators in the aorta and umbilical arteries, as well as in the middle cerebral artery of the fetus in women with GH differ from such indicators in healthy women. Decreased blood flow may indicate a risk of hypoxia and neurological problems for fetus. Therefore, it is important to diagnose GH in time and monitor fetal blood flow indicators using ultrasound to prevent possible complications and preserve the fetus and mother health.

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Section: вступunclassified

Characteristics of changes in fetal doppler blood flow parameters in women with gestational hypertension at different stages of pregnancy

Podolskyi,

Znak

2023

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“…In the absence of other obstetric indications for cesarean delivery, vaginal delivery is generally preferable in PPCM patients who are clinically stable. 43 Instrumental delivery may be considered to limit the cardiovascular effects of Valsalva maneuver. 44,45 If cesarean delivery is indicated, comanagement with obstetric anesthesiology is essential to determine the best choice of anesthesia and to optimize intraoperative fluid management.…”

Section: Delivery Considerations For Antepartum Patientsmentioning

confidence: 99%

“…Fetal status can be best optimized by stabilizing maternal clinical status, which is the primary determinant for timing of delivery. In the absence of other obstetric indications for cesarean delivery, vaginal delivery is generally preferable in PPCM patients who are clinically stable 43 . Instrumental delivery may be considered to limit the cardiovascular effects of Valsalva maneuver 44,45 .…”

Section: Clinical Managementmentioning

confidence: 99%

Peripartum Cardiomyopathy

Farrell¹,

Kuller

Goldstein

et al. 2021

Obstetrical &Amp; Gynecological Survey

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Importance: Peripartum cardiomyopathy is a rare form of heart failure due to left ventricular systolic dysfunction that affects women late in pregnancy and the postpartum period. A diagnosis of exclusion, peripartum cardiomyopathy can be difficult to diagnose in the context of the normal physiologic changes of pregnancy and requires a high index of suspicion.Evidence Acquisition: Original research articles, review articles, and guidelines on peripartum cardiomyopathy were reviewed.Results: The etiology of peripartum cardiomyopathy remains poorly defined, but theories include genetic predisposition, as well as myocardial inflammation and angiogenic dysregulation. Risk factors for this condition include hypertensive disorders of pregnancy, Black race, and maternal age older than 30 years. Patients with peripartum cardiomyopathy are at increased risk of acute clinical decompensation, cardiac arrhythmias, thromboembolic complications, and death. Primary treatment modalities include initiation of a medication regimen aimed at the optimization of preload and reduction of afterload. Maternal clinical status is the primary determinant for timing of delivery.Conclusions and Relevance: Prompt diagnosis and medical management by an interdisciplinary care team are vital for improving outcomes in patients with peripartum cardiomyopathy.Target Audience: Obstetricians and gynecologists, family physicians Learning Objectives: After participating in this activity, the provider should be better able to describe the incidence, proposed etiologies, and risk factors for peripartum cardiomyopathy; outline diagnostic tools and evidence-based clinical management of peripartum cardiomyopathy; and identify the disparities in outcomes and existing knowledge gaps.

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“…Peripartum Cardiomyopathy (PPCM) is a dilated cardiomyopathy which manifests in the last trimester of the pregnancy, during delivery or during the first six months postpartum (52). Its diagnosis is made by exclusion criteria: when the left ventricle ejection faction is below 45%, unexplained by any other underlying cardiovascular disease, during the mentioned period (53). In accordance with other cardiovascular diseases, its incidence has progressively increased over the course of recent years.…”

Section: Dna Damage On Peripartum Cardiomyopathymentioning

confidence: 99%

DNA Damage, an Innocent Bystander in Atrial Fibrillation and Other Cardiovascular Diseases?

Ramos

Brundel

2020

Front. Cardiovasc. Med.

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Atrial Fibrillation (AF) is the most common clinical tachyarrhythmia with a strong tendency to progress in time. AF is difficult to treat and therefore there is a great need to dissect root causes of AF with the ultimate goal to develop mechanism-based (drug) therapies. New findings related to mechanisms driving AF progression indicate a prime role for DNA damage-induced metabolic remodeling. A recent study uncovered that AF results in oxidative DNA damage and consequently excessive poly-ADP-ribose polymerase 1 (PARP1) activation and nicotinamide adenine dinucleotide (NAD +) depletion and finally atrial cardiomyocyte electrical and contractile dysfunction. This newly elucidated role of DNA damage in AF opens opportunities for novel therapeutic strategies. Recently developed PARP inhibitors, such as ABT-888 and olaparib, provide beneficial effects in limiting experimental AF, and are also found to limit atherosclerotic coronary artery disease and heart failure. Another therapeutic option to protect against AF is to replenish the NAD + pool by supplementation with NAD + or its precursors, such as nicotinamide and nicotinamide riboside. In this review, we describe the role of DNA damage-mediated metabolic remodeling in AF and other cardiovascular diseases, discuss novel druggable targets for AF and highlight future directions for clinical trials with drugs directed at PARP1-NAD + pathway with the ultimate aim to preserve quality of life and to attenuate severe complications such as heart failure or stroke in patients with AF.

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CE: Gestational Hypertension, Preeclampsia, and Peripartum Cardiomyopathy: A Clinical Review

Cited by 5 publications

References 78 publications

Characteristics of changes in fetal doppler blood flow parameters in women with gestational hypertension at different stages of pregnancy

Characteristics of changes in fetal doppler blood flow parameters in women with gestational hypertension at different stages of pregnancy

Peripartum Cardiomyopathy

DNA Damage, an Innocent Bystander in Atrial Fibrillation and Other Cardiovascular Diseases?

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