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Cardiac diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Saravanan Kuppuswamy, Sudarshan Balla
The outcome of pregnancy in women with corrected congenital heart disease depends on many factors including the success of the surgical repair, the extent of residual cardiac lesions, and the need for cardiovascular medications such as Coumadin. In addition, some maternal cardiac defects are associated with an increased incidence of congenital fetal cardiac and noncardiac defects that may affect fetal prognosis. Pregnancies following a heart transplant are usually not complicated (101,102,104,105). Peripartum cardiomyopathy may not recur after the heart transplant (102).
Case 38
Published in Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta, Clinical Cases, 2021
Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta
Peripartum cardiomyopathy is a condition of cardiac dysfunction taking place in the period around delivery and for several months afterwards. Key features are as follows:Reduced cardiac outputIncreased filling pressuresThe ejection fraction is nearly always reduced below 45%In future pregnancies, cardiac dysfunction may recur in the peri- and postpartum state
Cardiac conditions
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
There are many variations of cardiomyopathies, including acquired and inherited diseases such as peripartum cardiomyopathy (PPCM) and toxic, hypertrophic, dilated, restrictive, idiopathic and stress (Takotsubo syndrome) cardiomyopathies62,63,64. Risks and outcomes are likewise varied, from hypertrophic cardiomyopathy, which usually tolerates pregnancy well, to dilated cardiomyopathy, where advice against pregnancy may be given. Many, if not most, women with cardiomyopathies will already be diagnosed, and recommendation for preconception care and/or early referral to the cardiologist is necessary. However peripartum cardiomyopathy (PPCM) only occurs in pregnancy, and frequently without any predisposing/risk factors, making it particularly relevant to the midwife.
Developing locoregional evidence through comparison of WHO and national maternal near miss criteria: a cross sectional study experience from low resource setting
Published in Journal of Obstetrics and Gynaecology, 2022
Poloju Pragnia, Aashima Arora, Amol N. Patil, Pooja Sikka, Vanita Jain, Vanita Suri
Five patients diagnosed by GOI and missed by the WHO group were diagnosed to have cardiac disease (three patients with rheumatic heart disease with mitral Stenosis, two patients with postpartum cardiomyopathy). Among these, four were diagnosed in the antenatal period and the one in the postpartum period. This group of women was missed by WHO criteria as the cut off for abnormal pH in WHO criteria is 7.1, while in GOI criteria, pH below 7.3 is abnormal. A pH cut-off of 7.1 may lead to lesser identification of MNM women and the obstetric care needed. Peripartum cardiomyopathy women require careful selection of pharmacological intervention considering the foetal and maternal safety profile of drugs (Bhattacharyya et al. 2012). Another point required attention was that one study revealed that the pH <7.1 is well correlated with irreversible myocardial cell damage and mortality (Kalogeris et al. 2012). Therefore, our study findings validate the GOI MNM criteria and suggest necessary relaxation for WHO criteria pH value.
Management of Wolff-Parkinson-White syndrome in a patient with peripartum cardiomyopathy
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Snigdha Bendaram, Sherif Elkattawy, Muhammad Atif Masood Noori, Hardik Fichadiya, Sarah Ayad, Parminder Kaur, Raja Pullatt, Fayez Shamoon
Peripartum Cardiomyopathy (PPCM), also called pregnancy-associated cardiomyopathy, is an uncommon cause of heart failure during late pregnancy or early postpartum period. It is associated with significant morbidity and mortality related to heart failure and arrhythmias, which usually result from stretching of atrial and ventricular chambers [1,2]. It is estimated to account for less than 1% of pregnancy-associated cardiovascular complications, but the incidence has been increasing. In a large inpatient-based study on 9841 patients hospitalized for PPCM, 18.7% of the patients had an arrhythmia, of which 4.2% had ventricular arrhythmia, and 2.2% suffered cardiac arrest [3,4]. WPW syndrome is a pre-excitation/accessory pathway-induced arrhythmia associated with pregnancy and can be seen in combination with PPCM, which involves simultaneous management of systolic dysfunction and can get challenging at times.
Cardiac arrhythmias in pregnant women: need for mother and offspring protection
Published in Current Medical Research and Opinion, 2020
Theodora A. Manolis, Antonis A. Manolis, Evdoxia J. Apostolopoulos, Despoina Papatheou, Helen Melita, Antonis S. Manolis
A specific type of dilated CM in pregnancy is the peripartum CM (PPCM), which manifests towards the end of pregnancy or after delivery; most cases occur around childbirth95. Peripartum cardiomyopathy should be looked for in women with new-onset VT during the last 6 weeks of pregnancy or in the early post-partum period, especially in women of black ancestry, or in cases with pre-eclampsia, advanced maternal age, and multiple gestation pregnancy97,98. A notable feature of PPCM is its tendency to recur with subsequent pregnancies93. In a large US in-patient cohort of 9841 hospitalizations with a principal discharge diagnosis of PPCM, arrhythmias were present in 18.7% of patients, with VT recorded as the most common arrhythmia (4.2%)99. Approximately 2.2% of cases experienced cardiac arrest. Electrical cardioversion was performed in 0.3%, catheter ablation in 1.9%, pacemaker implantation in 3.4% and ICD implantation in 6.8% of hospitalizations for PPCM with arrhythmias. In-hospital mortality was 3-times more frequent in the arrhythmia cohort (2.1% vs. 0.7%).