1. CARDIOVASCULAR DISEASE
SIGN & SYMPTOMS IN PREGNANCY

2. Approximately 2% of pregnancies involve maternal C
Approximately 2% of pregnancies involve maternal C.V , associated with increased risk of both mother & fetus
Pregnancy complication may provide an opportunity for early identification of women at increased risk for C.V disease late in life….
Cardiac disease may sometimes be manifested in the first trimester because the hemodynamic change may compromise limited cardiac reserve

3. Due to declining incidence of RHD in western countries maternal cardiac disease is now prodominently congenital althouh at present the leading cause of maternal death are acquired disease with MI , Ao discection & CMP at top….

4. HEMODYNAMIC CHANGES Begin in the first trimester
Plasma volume begins to increase in 6th week & by the second trimester approaches 50% above baseline & tends to platu until delivery
Lesser rise in RBC mass
HR begins to increase to approximately 20%
Uterine blood flow increases with placental growth with fall in peripheral resistance

5. HEMODYNAIC CHANGES
reduced Peripheral resistance leads to slight fall in BP ,begins in the first trimester
Increased lower exterimity venous pressure leads to peripheral edema (80%)
30-50 % increase in CO by the end of first trimester

6. HEMODYNAMIC CHANGES
Volume overload may lead to hemodynamic compromise in pts with LV dysfunction
Stenotic valvular lesions are less well tolerated than regurgitant lesions

7. HEMODYNAMIC CHANGES During labor & delivery
Abrupt hemodynamic changes
Release of 500 cc blood to the circulation with each uterine contraction leads to increased CO & BP
50% increase in CO in second stage & even more at delivery
400 cc blood loss in NVD & 800 cc in C/S

8. HEMODYNAMIC… Abrupt increase in venous return at baby delivery
Autotransfusion continue in the h after delivery ( risk of pulmonary edema )
For the most pts NVD is feasible….

9. SYMPTOMS
Symptoms of normal pregnancy may mimic those of cardiac disease
Lightheadness
Dizziness
Shortness of breath
Peripheral edema
Syncope

10. PHYSICAL EXAMINATION
Reflects hemodynamic changes & may mimic those in cardiac disease:
Increased HR
Bound pulse volume
Elevated JVP by the middle of second trimester with brisk descends ( because of volume overload & reduced peripheral resistance )

11. PH.E Prominent apical impulse Loud S1 Up to 3/6 systolic murmur on LSB
Accentuated S2
*…ASD or PH
Cervical venous hum or mammary soufle
Peripheral edeme in advanced pregnancy