Heart Problems and Pregnancy....9

Heart Problems and Pregnancy....9

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15... Peripartum cardiomyopathy
The heart’s walls (myocardium) may be damaged (called cardiomypathy) late in pregnancy or after delivery. This time frame is called the peripartum period, and thus, this disorder is called peripartum cardiomyopathy. The cause is unknown. This disorder tends to occur in women with one of the following characteristics:
  • They have had several pregnancies.
  • They are 30 or older.
  • They are carrying more than one fetus.
  • They have preeclampsia (a type of high blood pressure that occurs during pregnancy).
In some women, heart function does not return to normal after pregnancy. Peripartum cardiomyopathy tends to occur in subsequent pregnancies, particularly if heart function has not returned to normal. Thus, women who have had this disorder are often discouraged from becoming pregnant again.

Peripartum cardiomyopathy can result in heart failure, which is treated as usual except that angiotensin-converting enzyme (ACE) inhibitors and aldosterone antagonists (spironolactone and eplerenone) are not used.

16...  Heart valve disorders
Ideally, heart valve disorders are diagnosed and treated before the women become pregnant. Doctors often recommend surgical treatment for women with severe disorders.
The valves most often affected in pregnant women are the aortic and mitral valves. Disorders that cause the opening of a heart valve to narrow (stenosis) are particularly risky.   Stenosis of mirtral valve  can result in fluid accumulating in the lungs (pulmonary edema) and a rapid, irregular heart rhythm 
Women with  mitral valve prolapse usually tolerate pregnancy well.

Treatment

  • Avoidance of certain drugs during pregnancy
  • During labor, an epidural injection
Doctors advise pregnant women with a heart disorder to do the following:
  • Schedule frequent check-ups
  • Avoid gaining excess weight
  • Avoid stress
  • Get enough rest
Anemia, if it develops, is promptly treated.
Certain drugs used to treat heart disorders are not used during pregnancy. They include angiotensin-converting enzyme (ACE) inhibitors, aldosterone antagonists (spironolactone and eplerenone), and certain drugs used to treat abnormal heart rhythms (antiarrhythmic drugs, such as amiodarone). Which other heart drugs are continued during pregnancy depends on how severe the heart disorder is and what the risks to the fetus are. For example, warfarin is usually avoided because it can increase the risk of birth defects. However, it may be given to women who have a mechanical heart valve because warfarin reduces the risk that blood clots will form in these valves. Such clots can be fatal.
If the heart is not functioning well, women may be given digoxin (used to treat heart failure) and advised to limit their activities as much as possible, beginning at 20 weeks of pregnancy.
During labor, pain is treated as needed. If women have a severe heart disorder, doctors may inject an anesthetic into the lower back—into the space between the spine and the outer layer of tissue covering the spinal cord (epidural space). This procedure is called an epidural injection. This anesthetic blocks sensation in the lower spinal cord, reducing the stress response to pain and the urge to push. The purpose is to reduce the strain on the heart. Pushing during labor strains the heart because it makes the heart work harder. Because these women cannot push, the baby may have to be delivered with forceps or a vacuum extractor.
An epidural injection should not be used if women have aortic valve stenosis. A local anesthetic or, if needed, a general anesthetic is used instead.
Women are monitored closely immediately after delivery and are checked periodically by a cardiologist for several weeks afterward.

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