1. Cardiovascular disease in pregnancy Cardiovascular disease in pregnancy Dr.Z Allameh MD

2. A bout 1% heart disease  Rheumatic heart disease  Congenital heart disease  Hypertensive heart disease

3. Physiological considerations with heart disease in pregnancy

4. Hemodynamic changes in N.l P  Cardiac output +43  Heart rate +17  Left ventricular stroke work index +17  Vascular resistance systemic -21  Pulmonary -34  Mean arterial pressure +4  Colloid osmotic pressure -14

5. Diagnosis of heart disease  ElectroCardioGraphy  Chest X-RAY  Echocardiography

6. Clinical indicators of heart disease during pregnancy  Symptoms Progressive dyspnea or orthopnea Noctural cough,Hemoptysis,Syncope,Chest pain  Clinical findings Cyanosis,clubbing of fingers Persistent neck vein distention Systolic murmur grade 3/6 or greater Diastolic murmur,Cardiomegaly Persistent arrhythmia Persistent split –second sound Criteria for pulmonary hypertension

7. Clinical classification  Class I  Class II  Class III  Class IV

8. Preconceptional counseling

9. General management  Class I, II labor and delivery Group 1_ Minimal Risk Atrial septal defect Ventricular septal defect Patent ductus arteriosus Pulmonic or tricuspid disease Fallot tetralogy,corrected Bioprosthetic valve Mitral stenosis,NYHA

10. Group 2_ Moderate Risk 5-15% 2A:  Mitral stenosis,NYHA classes III, IV  Aortic stenosis  Aortic coarctation without valvar involvement  Fallot tetralogy,uncorrected  Previous myocardial infarction  Marfan syndrome, normal aorta 2B: Mitral stenosis with atrial fibrilation Artificial valve

11. Group 3- Major Risk 25-50%  Pulmonary hypertension  Aortic coarctation with valvar involvement  Marfan syndrome with aortic involvement

12. Intrapartum heart failure

13. Management of class III, IV