1. Heart Disease In Pregnancy
Amal El Sayed

2. Cardiac Diseases in Pregnancy are Classified into:
Mitral Valve Prolapse:
Rheumatic heart diseases
Congenital heart diseases
Cardiac arrhythmias
Peripartum cardiomyopathy

3. New York Heart Association’s Functional Classification of Heart Disease
Class I: No sign or symptoms of cardiac decompensation
Class II: No symptoms at rest but minor limitation of physical activity
Class III: No symptoms at rest but marked limitation with physical activity
Class IV: Symptoms at rest, discomfort increases with any kind of physical activity

4. Rheumatic Heart Disease
Most common Heart disease in pregnancy
Most common lesion is mitral stenosis
The condition deteriorates with pregnancy due to the increase in cardiac output.
Asymptomatic patients may suffer from heart failure or pulmonary edema
Atrial Fibrillation and thromboembolic disease may happen
Other complications include subacute bacterial endocarditis
Antibiotic prophylaxis is essential. Penicillin is the drug of choice

5. Congenital Heart Disease
Atrial Septal Defects
Ventricular septal defects
Primary pulmonary hyper tension
Transposition of the great vessels
If surgically corrected in childhood, patients do well. If not, decompensation may happen in pregnancy with increase maternal mortality during pregnancy and post partum.

6. Cardiac Arrythmias Supraventricular tachycardia is the most common.
Usually associated with cardiac structural defects.

7. Peripartum Cardio Myopathy
Rare
No pre-exisiting cardiac lesions
Occurs only in pregnancy
Occurs with preeclampsia and HTN
Dilation of heart chambers with heart failure
High mortality (at least 20%)
If patient survives, condition may recurre.

8. Managemnt Class I, II: Small risk Class III, IV: Big risk
All cardiac patients should be managed by a cardiologist
ECG
Echo
Avoid excess weight gain
Low-sodium diet to avoid edema
Adequate rest to avoid stress
Avoid anemia
Anti Coagulation

9. Mode of Delivery Vaginal, unless there is obstetric indication
But avoid pushing by using forceps or vacuum
Watch for fluid overload post-delivery, as this may precipitate heart failure

10. Renal Disease in Pregnancy

11. Asymptomatic Bacteruria
The presence of bacteria in urine without symptoms
Should be treated aggressively in pregnancy to avoid the development of UTI
UTI most common organism E coli.
Common in pregnancy due to:
Stasis of urine
Relaxation of urinary tract due to progesterone effect

12. Pyelonephritis Common due to:
Stasis of urine due to dilation and relaxation of urinary system
Pressure of the uterus on the ureters (especially right side)

13. Clinical Picture Fever, chills Dysuria Frequency Loin pain
Bacteria and pus in urine

14. Treatment IV hydration IV Antibiotics Analgesia
The aim of treatment is to prevent septicemia and premature labor

15. Acute Chronic Glomerulonephritis
Causes destruction of renal parenchyma
Secondary to infection or autoimmune disorder

16. Clinical Picture Fever Loin pain Casts in the urine Edema Protein urea
Renal conditions become worse in pregnancy
May lead to HTN and preeclampsia eclampsia

17. Treatment of the cause, and follow-up with KFTs which include: Na, K, CL, Bu, N, Creatine and Creatine clearance

18. Renal Failure Acute: Usually secondary to hypovolemia
Chronic: Long standing renal damage