Management of cardiac disease in pregnancy

Burt, Christiana; Durbridge, J.

doi:10.1093/bjaceaccp/mkp005

Cited by 30 publications

(29 citation statements)

References 8 publications

(9 reference statements)

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“…This increase in cardiac output is accomplished by an increase in ventricular end-diastolic volume, wall mass, and contractility, which creates an increase in stroke volume and heart rate. Due to these alterations, pregnant women are placed at higher risk for developing comorbidities such as cardiac arrhythmias that range from benign to life threatening [4, 5]. …”

Section: Discussionmentioning

confidence: 99%

The Unexpected Pitter Patter: New-Onset Atrial Fibrillation in Pregnancy

White

Welch

Brown

2015

Case Reports in Emergency Medicine

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Background. Atrial fibrillation is a relatively uncommon but dangerous complication of pregnancy. Emergency physicians must know how to treat both stable and unstable tachycardias in late pregnancy. In this case, a 40-year-old female with a cerclage due to incompetent cervix and previous preterm deliveries presents in new-onset atrial fibrillation. Case Report. A previously healthy 40-year-old African American G2 P1 female with a 23-week twin gestation complicated by an incompetent cervix requiring a cervical cerclage presented to the emergency department with intermittent palpitations and shortness of breath for the past two months. EMS noted the patient to have a tachydysrhythmia, atrial fibrillation with rapid ventricular response. She was placed on a diltiazem drip, which was titrated to 15 mg/hr without successful rate control. Her heart rate remained in the 130s and the rhythm continued to be atrial fibrillation with RVR. Digoxin was then added as a second agent, and discussions about the potential risks of cardioversion in pregnancy ensued. Fortunately, the patient converted to sinus rhythm before cardioversion became necessary. The digoxin was discontinued; the diltiazem was also discontinued after the patient subsequently developed hypotension. “Why Should Emergency Physicians Be Aware of This?” New-onset atrial fibrillation is rare in pregnancy but can increase the mortality and morbidity of the mother and fetus if not treated promptly.

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Section: Discussionmentioning

confidence: 99%

The Unexpected Pitter Patter: New-Onset Atrial Fibrillation in Pregnancy

White

Welch

Brown

2015

Case Reports in Emergency Medicine

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“…10,11 However, vaginal delivery causes smaller shifts in blood volume and fewer complications including reduced blood loss, infection and thromboembolic events 12 when compared to caesarean delivery. An assisted second stage helps in reduced cardiac work and decreased maternal expulsive efforts.…”

Section: Route Of Deliverymentioning

confidence: 99%

Management of labour and delivery in congenitally corrected transposition of great arteries

Dhir

Racine

Gratton

et al. 2015

Acta Anaesthesiol Scand

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A descriptive case report of the labour and delivery management of a 28-year-old woman who presented with congenitally corrected transposition of great arteries, dextrocardia, systemic ventricular dysfunction and junctional tachycardia. Patients with congenitally corrected transposition have a thin-walled morphological right ventricle as the systemic circulatory pump. The stress of increased cardiac output can lead to congestive heart failure, systemic atrioventricular valve regurgitation and arrhythmias. We used minimally invasive continuous cardiac output monitoring, fluid balance optimization and good maternal pain control to prevent decompensation and achieve vaginal delivery with a good maternal and neonatal outcome.

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“…At the same time vascular peripheral resistance reduces and heart rate increases. 2 On the other hand, there is an increased level of clotting cascade factors resulting in a higher generation of thrombin 14 while anticoagulant factors such as protein S and C reduce their activity. Moreover there is a decreased production of tissue plasminogen activator.…”

Section: Brief Overview On Cardiovascular Physiology During Pregnancymentioning

confidence: 99%

Acute Coronary Syndrome in Pre- and Post-partum Women – A Review

Aprigliano

Palloshi

Morici

et al. 2013

Interventional Cardiology Review

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Acute coronary syndrome (ACS) during pregnancy and the post-partum period are weighed by a high mortality rate for the mother and foetus. They should be considered as multifactorial diseases with a special role for sexual hormones. In this setting, ACS is mostly related to an early atherosclerotic disease, even if other conditions are responsible. Indeed, an important part is due to spontaneous coronary artery dissection, more common during delivery and the post-partum period. In the remaining situation, an isolated intracoronary thrombus or a normal angiographic pattern can be found at angiography. Pathophysiology is still uncertain with different hypothetical mechanisms. Prompt diagnosis of ACS and aetiology are essential for an optimal therapeutic strategy. Difficulties in treatment management is a matter for debate, especially in pre-partum women. In the last two decades improvements of diagnostic tools, coronary angiography and subsequent percutaneous treatment have changed the natural history of this rare condition.

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Management of cardiac disease in pregnancy

Cited by 30 publications

References 8 publications

The Unexpected Pitter Patter: New-Onset Atrial Fibrillation in Pregnancy

The Unexpected Pitter Patter: New-Onset Atrial Fibrillation in Pregnancy

Management of labour and delivery in congenitally corrected transposition of great arteries

Acute Coronary Syndrome in Pre- and Post-partum Women – A Review

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