CARDIAC DISEASE AND PREGNANCY

BY GROUP 4 :
SULASTRI
ULFAH
UMMU SALMAH
WILDA HAIRANI
YULIANTI SYAM
 FOREWORD

Praise the presence of God Almighty because of His blessings and mercy
the compilers were given health so that the paper entitled "cardiac disease and
pregnancy" could be completed within a predetermined period of time.
This paper is structured to fulfill the task of the group of ENGLISH courses,
where material sources are adapted from relevant books and internet libraries in order
to support the accuracy of the material that will be presented later.
The authors are fully aware that this paper is far from perfect, given the
limitations of time and ability. Therefore, the authors expect constructive criticism
and suggestions.

The authors

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 TABLE OF CONTENTS

Foreword........................................................................................................
Table of Contens..........................................................................................
Chapter I. Intoductions
A. Background .........................................................................................
Chapter II. Review Of Revenue
A. Definition .............................................................................................
B. Etiologhy ..............................................................................................
C. Cause ...................................................................................................
D. Signs of Symptomps ............................................................................
E. Handling ...............................................................................................
F. Prognosis ..............................................................................................
Chapter III. Discussion
A. Pregnancy With Heart Disease.............................................................
B. The Basic Concept Of Security Management ......................................
Chapter IV. Closed
Source ..............................................................................................

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 CHAPTER I
INTRODUCTION

A. BACKGROUND
The heart is an organ that is very important for humans, because the heart is
needed to pump blood throughout the body so that the body gets oxygen and
food essence needed for the body's metabolism. Therefore, the heart needs to be
maintained so that it can perform its functions properly.
Pregnancy will cause extensive physiological changes in the cardiovascular
system, and result in disruption of the heart and blood flow so that it needs to be
considered if pregnancy occurs. In healthy women can adapt to changes in
hemodynamics (heart rate, respiratory system, blood volume, hormones, etc.).
But these changes can be a threat to women with heart disease. Although
heart disease rarely occurs de novo during pregnancy, many women with heart
disease are known beforehand or women with potential heart disease experience
pregnancy.
The incidence of heart disease in pregnancy is around 1% and continues to
increase. This change may be the result of advances in management of heart
disease over the past few years, this has led to an increase in the number of
women with congenital heart disease reaching adulthood and being able to give
birth. Advances in operating techniques and medica mentosa have caused a
dramatic decline in rheumatic heart disease compared to congenital heart disease
in the western world.
But in developing countries, rheumatic heart disease is still quite high. This
will add to the main cause of death in maternity, accounting for 35 indirect
deaths in England from 1997-1999. In Malaysia, a report published in 2000, there
were 77 deaths from heart disease in pregnancy, about 16.4% of all deaths in

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pregnancy from 1995-1996. In addition, there are still morbidity to consider
regarding congestive heart failure, thromboembolic complications, and heart
rhythm disorders. Complications in the fetus include miscarriage, intrauterine
growth restriction, and premature birth

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 CHAPTER II
REVIEW OF REVENUE

A. Definition
Pregnancy will cause changes in the cardiovascular system. Women with
cardiovascular disease and becoming pregnant, there will be reciprocal
influences that can harm the woman's chances of life. In normal heart pregnancy,
women can adjust their work to physiological changes.
In a non-pregnant condition, heart disease itself has experienced problems
in pumping blood throughout the body. Especially when pregnant. During
pregnancy from the sixth week the mother's blood volume increases up to 50%
due to the blood thinning process. Blood flow will be more pumped into the
uterine blood circulation through the placenta to meet the needs of fetal growth
so that the work of the heart becomes heavier.

B. Etiology
1. Congenital Heart Disease
Heart disease is caused by congenital heart abnormalities and heart
muscle disease, heart disease of pregnant women is still a known cause of
death such as: shortness of breath, syanosis, pulse disorders, oedeme, heart
palpitations. Plasma volume increase that starts approximately at the end of
the first trismester and reaches its peak in weeks 32-34 weeks which then
persists in late pregnancy trismester where plasma volume increases by 22%,
increased volume of red blood cells can cause anemia, disulosional.
Heart disease in pregnant women can affect the fetus, the fetus is likely to
be born: perematur, severe heart disease in pregnant women suddenly
worsens the fetus can die, the baby is born with weak apgar.

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2. Heart Disease Due to Rheumatic Fever
Most heart disease in pregnancy is caused by rheumatic fever. The
diagnosis of rheumatic fever in pregnancy is often difficult, if it is based on
the Jones criteria as a basis for the diagnosis of active rheumatic fever.
The most manifestations are migrant polyarthritis and carditis. Pregnancy
changes that complicate the diagnosis of rheumatic fever are joint pain in a
pregnant woman may be due to a posture that carries a greater burden in
relation to her pregnancy and increased blood sedimentation rate and
leukocyte count.
If there is rheumatic fever in pregnancy, the prognosis will be bad. The
activity of rheumatic fever can be suspected if there are:
a. Subfebris temperature with tachycardia faster than it should be
b. Leukocytosis and high sedimentation rate
c. Sounds of heart swings that change their nature or place

3. Hypertension Heart Disease

Hypertensive heart disease is often found in pregnancy, especially in the
elderly and difficult to overcome. Whatever the basis of this disease, essential
hypertension, kidney disease or aortic co-coefficient, pregnancy will get toxic
complications in one third of the cases with high mortality in both mother
and fetus. The main goal of treating hypertensive heart disease is to prevent
heart failure. Treatment is aimed at reducing blood pressure and controlling
fluid and electrolytes. These changes are caused by:
a. Hypervolaemia: starting at 8 weeks of pregnancy and reaching its peak
at 28-32 weeks ago
b. The heart and diaphragm are pushed upward due to uterine enlargement.
In pregnancy:
a. Heart rate and pulse: increase
b. Heart beat: increase

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 c. Blood pressure: decreases slightly.
So it can be understood that pregnancy can increase heart disease and
can even cause heart failure (cord decompensation). Frequency of heart
disease in pregnancy ranges from 1-4%. Effect of pregnancy on heart disease,
dangerous times for sufferers are:
a. At 32-36 weeks of pregnancy, where the blood volume reaches its peak
(hypervolumia).
b. At the second stage, where women exert effort to strangle and require a
heavy heart work.
c. In postpartum, where blood from the placenta intervilus space is born, it
now enters the mother's blood circulation.
d. During childbirth, because there is a possibility of infection

C. Cause
As a result of heart disease in pregnancy, an increase in heart rate in
pregnant women and the longer the heart will experience fatigue. Finally, the
delivery of oxygen and nutrients from the mother to the fetus through the
placenta becomes disrupted and the amount of oxygen received by the fetus will
decrease for a longer time. The fetus is experiencing growth disorders and lack of
oxygen.
As a consequence, pregnant women have the potential to experience
miscarriage, premature birth (birth before enough months), born with low Apgar
or born dead, and fetal death in utero (KJDR). Especially if during pregnancy the
mother does not receive proper treatment for antenatal care and treatment.

D. Sign of Symptoms
Following signs and symptoms of heart disease:
1. tired easily
2. panting breath

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 3. orthopnea (shortness of breath, except in an upright position)
4. coughing at night
5. hemoptysis
6. syncope
7. chest pain
8. family history

E. Hemodynamic Changes Occurring During Pregnancy

Cardiac metabolism is altered during pregnancy in order to accommodate both
foetal needs and increased demands for cardiac work. The latter reflects the large
haemodynamic shifts that occur during pregnancy. Some uncertainty remains over
the magnitude and direction of these shifts despite numerous studies because
inconsistent experimental conditions have often led to contradictory measurements.
The discrepancies are likely attributable to a number of factors, including:
1. Small sample sizes often lead to conclusions more relevant to individual
profiles rather than to the general population.
2. Maternal age, height, BMI, and parity, which can result in varying degrees of
cardiac changes, are not always controlled for.
3. Different population groups have different basal cardiac values. For example,
young healthy African Americans have lower resting cardiac indices and
higher resting systemic vascular resistance than their Caucasian counterparts.
4. The maternal position greatly affects echocardiography, because the supine
position can obstruct the inferior vena cava and decrease cardiac preload.
5. Other methods, such as Holter monitor, thoracic electrical bioimpedance,
catherization, and the thermodilution technique, have also been widely used,
with varying results.
6. Lastly, many haemodynamic studies use, for practical reasons, the early
pregnant or postpartum stage as comparison controls, but important alterations
in cardiac parameters can still be detected at these stages.

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 Cardiac function, both systolic and diastolic, must be affected by the increase
in preload and decrease in afterload of pregnancy, but different studies
surprisingly come to quite different conclusions. The limited data on diastolic
function during pregnancy have been inconsistent; some studies have reported a
decrease in diastolic function near the end of pregnancy, while others have
reported minor to no changes.
While systolic function is better scrutinized, it is similarly inconsistent:
increases, decreases, and no change have been reported. For example, ejection
fraction has been reported with much variability, with increases, decreases, and
no change described with comparable frequency. This aspect of cardiac changes
during pregnancy thus remains incompletely defined.

F. Handling
1. Giving understanding to pregnant women to carry out regular antenatal
supervision.
2. Collaboration with internal medicine experts or cardiologists
3. Prevention of excessive weight gain and water retention. If there is anemia,
it must be treated.
4. The onset of hypertension or hypotension will burden the work of the heart,
this must be treated.
5. If there is a rather severe complaint, such as shortness of breath, respiratory
infections, and cyanosis, the patient must be hospitalized.
6. Antenatal visit scheme: every 2 weeks before pregnancy 28 weeks and 1
time a week thereafter.
7. Have enough rest, get enough sleep, a low-salt diet, and limit the amount of
fluid.
8. Special treatment depends on the class of disease:
a. Class I
Does not require additional treatment.

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 b. Class II
Usually does not require additional therapy. Reducing physical work,
especially between 28-36 weeks of pregnancy.
c. Class III
Requires digitization or other drugs. We recommend that you be
hospitalized since 28-30 weeks of pregnancy.
d. Class IV
Must be hospitalized and given treatment, in collaboration with a
cardiologist.

G. Prognosis
1. For mother
Depending on the severity of the disease, age and other complications.
Treatment supervision, childbirth leaders, and collaboration with patients
and adherence to compliance with the prohibition, determine the prognosis.
Overall maternal mortality rate: 1-5% Maternal mortality rate for
sufferers of weight: 15%
2. For infants
If heart disease is not too severe, it does not affect perinatal mortality.
But in severe illness, the prognosis will be bad because fetal distress will
occur.

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 CHAPTER III
DISCUSSION

A. PREGNANCY WITH HEART DISEASE

Normal women who experience pregnancy will experience physiological
and anatomic changes in various organ systems associated with pregnancy due to
hormonal changes in the body. Changes that occur can include the
gastrointestinal, respiratory, cardiovascular, urogenital, musculoskeletal and
nervous systems. Changes that occur in one system can give effect to each other
system and in overcoming abnormalities that occur must consider
changes that occur in each system, these changes occur due to metabolic
needs caused by the needs of the fetus, placenta and uterus. Normal adaptation
experienced by a woman who experiences pregnancy including the
cardiovascular system will provide symptoms and signs that are difficult to
distinguish from symptoms of heart disease. This situation causes some
abnormalities that cannot be tolerated during pregnancy.

B. THE BASIC CONCEPT OF SECURITY MANAGEMENT

1. ASSESSMENT OF DATA
Assessment is a systematic approach to collecting data grouping data and
analyzing data so that problems and client conditions can be identified. In this
first step all accurate information is collected from all sources related to the
client's conditions collected data
a. Subyective Data
b. Objective Data

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2. FAST DATA
a. Diagnosis
G1P0A0 is 34 weeks pregnant with a single, live, intra uterine fetus with
heart disease
b. Problems
The mother complained of pain in the left chest and was unable to perform
normal activities.

c. Needs
1) KIE to mothers about signs of heart disease.
2) Management of heart disease in pregnant women.

3. IDENTIFYING DIAGNOSIS / POTENTIAL PROBLEMS

In this step we identify other financial problems or diagnoses based on the
series of problems and diagnoses that have been identified. This step requires
anticipation, if possible to be prevented while observing the client, the
midwife is expected to be prepared if the diagnosis of this potential problem
really occurs.
Possible diagnoses or potential problems that arise: None

4. IDENTIFY NEEDS THAT REQUIRE IMMEDIATE HANDLING

Identify the need for immediate action by the midwife or doctor and or to be
consulted or handled together with other health team members that are
appropriate to the client's condition. Possible immediate action in cases of
pregnancy abnormalities
a. Perform O2 inhalation installation
b. Collaborate with doctor Sp.OG
c. Refer to a more complete health facility for handling heart disease

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5. PLANNING COMPREHENSIVE CARE
A care plan must be approved by both midwives and clients so that
planning can be carried out effectively. All decisions must be rational and
valid based on theories and valid assumptions about what will and will not be
done. Planning actions that might be done include
a. Tell the mother about the results of the examination / condition of the
mother.
b. Explain to the mother about the pregnancy experienced
c. Tell the mother about signs of symptoms.
d. Tell the mother about the risks that will be experienced in pregnancy
e. Give KIE nutrition to pregnant women
f. Make a referral
g. Documentation

6. IMPLEMENTATION
a. Tell the mother the results of the examination\
b. Explain to the mother that her pregnancy has a complication of heart
disease and if not treated immediately will disrupt the health of the
mother and fetus and the cause of heart disease, among others due to:
Hypervolaumia, uterine enlargement, rheumatic fever.
c. Notify the mother of signs and symptoms of heart disease such as:
Arrhythmia, Enlargement of the heart, fatigue, dyspenea, irregular pulse,
pulmonary edema, cyanosis.
d. Tell the mother about the risks that will occur in pregnancy with heart
disease such as:
1) Abortion can occur
2) Prematurity: born not enough months.
3) Dysmaturitis: full-term birth but low weight.
4) Born with low apgar or stillbirth.

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 5) Jani's death in birth (KJDL)
6) Tell the mother to eat, nutritious foods that contain protein such as tofu,
tempeh, eggs and fish. Carbohydrates such as rice, bread, corn, cassava
and others. Vitamins, for example fruits and vegetables. Minerals such
as milk and green-green vegetables. Notify the mother not to eat foods
that interfere with health such as food that contains a lot of
preservatives, drink alcoholic beverages, drink herbs and smoke.
7) Conduct referrals to more complete health facilities for handling
diseases.
8) Conduct Documentation

7. EVALUATION
Care for midwifery management is carried out continuously so it needs to
be evaluated for every action that has been given to be more effective.
a. Mother said she already knew about the situation
b. I already know that her pregnancy has complications.
c. Mother has known about the signs and symptoms of heart disease,
marked by the mother nodding her head.
d. Mother already knows about the risks that will occur in her pregnancy.
e. Mother said she already knew about the nutrition of pregnant women and
the mother could explain again
f. Reference has been made to a more complete health facility for handling
heart disease
g. Documentation has been done

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 CHAPTER IV
CLOSED

A. Conclusion
Pregnancy will cause changes in the cardiovascular system. Women with
cardiovascular disease and becoming pregnant, there will be reciprocal influences
that can harm the woman's chances of life. In normal heart pregnancy, women can
adjust their work to physiological changes. Special treatment depends on the class
of disease:
1. Class I
Does not require additional treatment.
2. Class II
Usually does not require additional therapy. Reducing physical work,
especially between 28-36 weeks of pregnancy.
3. Class III
Requires digitization or other drugs. We recommend that you be hospitalized
since 28-30 weeks of pregnancy.
4. Class IV
Must be hospitalized and given treatment, in collaboration with a cardiologist.

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 SOURCE

Samuel, P. 2016. Diagnosing Cardiac Disease During Pregnancy. Online

(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928175/) accessed date 7
Oct 2018.

Franklin, J.W. 2013. Cardiac Disease In Pregnancy. Online(https://www.ncbi.nlm

.nih.gov/pmc/articles/PMC3066821/) accessed date 7 Oct 2018.

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