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The number of women of childbearing age who have heart disease is diminishing as more
and more congenital heart anomalies are corrected in early infancy. The cardiovascular disease
which was once a major threat to pregnancy now complicates only approximately 1% of all
pregnancies.
The cardiovascular disorders that most commonly cause difficulty during pregnancy are
valve damage concerns caused by rheumatic fever or Kawasaki disease and congenital anomalies
such as atrial septal defect or uncorrected coarctation of the aorta. Aortic dilatation may occur
from Marfan syndrome and is also a concern.
Class Description
I Uncompromised. Ordinary physical activity causes no discomfort. No symptoms
of cardiac insufficiency and no anginal pain.
II Slightly compromised. Ordinary physical activity causes excessive fatigue,
palpitation, and dyspnea or anginal pain.
III Markedly compromised. During less than ordinary activity, woman experiences
excessive fatigue, palpitations, dyspnea, or angina pain.
IV Severely compromised. Woman is unable to carry out any physical activity without
experiencing discomfort. Even at rest, symptoms of cardiac insufficiency or angina
pain are present.
A woman with class I or II heart disease can expect to experience a normal pregnancy
and birth. Women with class III can complete a pregnancy by maintaining special interventions
such as bed rest. Women with class IV heart disease are usually advised to avoid pregnancy
because they are in cardiac failure even at rest and when they are not pregnant.
Risk Factors
Age
Heredity
Obesity
High cholesterol and blood pressure
Insulin resistance or diabetes
Manifestations
Pulmonary edema occurs when the pressure in the pulmonary vein reaches a point of
about 25 mmHg and fluid begins to pass from the pulmonary capillary membranes into
the interstitial spaces surrounding the lung alveoli and then to the alveoli themselves.
Shortness of breath it occurs because the pulmonary edema interferes with oxygen-
carbon dioxide exchange.
Productive cough with blood-speckled sputum it occurs when the pulmonary
capillaries rupture under the pressure and small amounts of blood leak into the alveoli.
Increase respiratory rate the chemoreceptors stimulate the respiratory center to
increase the respiratory rate when the oxygen saturation of the blood decreases from
dysfunction of the alveoli.
Increase heart rate
Increased fatigue, weakness and dizziness
Sleeplessness due to severe pulmonary edema
Paroxysmal nocturnal dyspnea it is the condition that when suddenly wakes at night
with shortness breath. Occurs because heart action is more effective when she is at rest.
Treatments
Right-sided heart failure occurs when the right ventricle is overwhelmed by the amount
of blood received by the right atrium from the vena cava. It can caused by unrepaired congenital
heart defect such as pulmonary valve stenosis, but the anomaly most apt to cause right-sided
heart failure in women of reproductive age is Eisenmenger syndrome, a right-to-left atrial or
ventricular septal defect with an accompanying pulmonary valve stenosis.
Manifestations
Manifestations
Shortness of breath
Chest pain
Non-dependent edema
Heart increase in size
Treatment
Medical management
Percutaneous therapy
Aspirin is relatively safe, and its use can prevent pre-eclampsia inhigh risk women.
Clopidogrel no teratogenic effects in animal studies, serious complications have
not been documented in case reports.
Diuretics can be used during pregnancy, if used before pregnancy and whenever is
necessary. Not indicated in pre-eclampsia; there is some concern that their use might
promote the occurrence of pre-eclampsia.
Beta-blockers have been used extensively during pregnancy with good safety
profile and no teratogenic effects. Monitoring of fetal growth is recommended as fetal
growth retardation has been described. Can be used during breastfeeding, avoiding
nursing infants at the time of peak beta-blocker plasma levels, usually occurring 3 to
4 hours after a dose.
Calcium channel blockers
Digoxin is considered safe through pregnancy when not exceeding
therapeutic levels. Has been considered the drug of choice in treating fetal
arrhythmias.
Adenosine treatment of choice for supraventricular tachycardia during
pregnancy; short half-life.
Procainamide can be used with relative safety to treat a variety of maternal
and fetal arrhythmias. Chronic therapy is not recommended during pregnancy
because of lupus like effects.
Lidocaine has been used as local anesthetic during pregnancy and is
relatively safe.
Flecainide has become the treatment of choice for fetal supraventricular
tachycardia. It is especially useful in treating cases refractory to digoxin and
in those complicated by hydrops fetalis.
Chamaidi, A. & Gatzoulis, M. (2006). Heart disease and pregnancy. Retrieved from
http://www.hellenicjcardiol.com/archive/full_text/2006/5/2006_5_275.pdf
Pilliteri, A. (2014). Maternal & child health nursing: Care of the childbearing & childrearing
family. Philippines: Lippincott Wiliams & Wilkins.