Cardiovascular disease in pregnancy

Article written by Dr. Nguyen Hong Son - Department of Medical Examination and Internal Medicine, Vinmec Times City International General Hospital

During a normal pregnancy, a woman's body undergoes hormonal changes, so there is an increase in both plasma volume (due to water retention and salt retention) and blood cell volume (due to increased red blood cell count) . The disproportionate increase between these two factors in the blood causes physiological anemia in pregnant women.
The mother's heart rate increases during 40 weeks of pregnancy, in addition to increased sympathetic force and normal heat production. As a result, cardiac stroke volume continues to increase until the third trimester, when vena cava return can be compressed by the pregnant uterus. Maternal cardiac output increases by 30-50% in a normal pregnancy.

Hyperventilation (due to an increase in the number of breaths per minute) Edema (due to fluid retention and uterine compression on the inferior vena cava) Dizziness, feeling light-headed (decreased systemic vascular resistance and compression of the vena cava) vena cava) palpitations (heart rate increased by 10-15 beats/min)

Generalized edema and paroxysmal nocturnal dyspnea are not normal symptoms of pregnancy and should be carefully evaluated. Syncope, possibly due to hypotension, obstructive valvular disease (aortic stenosis, mitral stenosis, pulmonary valve stenosis), pulmonary hypertension, pulmonary embolism, tachycardia or bradycardia Chest pain, possibly indicative of aortic dissection, pulmonary embolism, angina or even a heart attack. For women who have children later in life, the older they get, the higher the odds of cardiovascular risk factors. Post-harvest is less common in developed countries

Need to prevent infective endocarditis in women who have given birth vaginally and have previous infective endocarditis, prosthetic valves, and congenital heart disease who have undergone surgery within 6 months or after 6 months, but there is residual flow, surgery to create a shunt or an anastomosis device between the aortopulmonary circulation, after heart valve transplantation. According to the American Heart Association guidelines for caesarean section, there is no indication for the prevention of infective endocarditis despite the fact that it is routinely performed.
>>> Echocardiography in infective endocarditis

Electrocardiogram and echocardiogram are safe. A chest x-ray can be performed with good coverage of the pelvis. Exercise testing with exercise as low as 70 % of maternal MR is safe, with a low risk of fetal bradycardia or fetal distress. Transesophageal echocardiography can be performed with appropriate sedation and close monitoring if the benefits and risks are weighed. Cardiac catheterization, balloon angioplasty, angioplasty, and percutaneous interventional procedures are tests and invasive treatments that can be safe for the mother and fetus with good pelvic shielding. Contraindications to computed tomography and magnetic resonance imaging in pregnant women.

Mitral stenosis, aortic stenosis, and moderate to severe pulmonary stenosis are poorly tolerated in pregnancy. Patients should be discussed whether to consider angioplasty or valve replacement before becoming pregnant. If the patient is severely ill, these procedures can be performed during high-risk pregnancy. Pulmonary hypertension is also a high risk with pregnancy.

Warfarin anticoagulants are contraindicated in the first and last trimesters of pregnancy. As recommended by the American College of Thoracic Medicine, the recommended anticoagulation regimen is as follows:
Initiate titration of unfractionated heparin (UFH) every 12 hours until an aPTT of 2 to 3 is achieved. Initiate titration of low molecular weight heparin (LMWH) twice daily to achieve anti-Factor Xa levels between 0.7 and 1.2 U/ml Unfractionated heparin (UFH) or low molecular weight heparin administered weekly 13th trimester, then switch to Warfarin until the middle of the 3rd trimester, then back to UFH or LMWH. Oral anticoagulation requires long-term treatment after delivery in accordance with the regimen, should be taken at the same time in the afternoon. Low-dose aspirin is not mandatory in high-risk pregnant women with mechanical valves. Mothers taking warfarin can breastfeed.

Congenital heart disease with right-to-left shunt (cyanotic congenital heart disease) is often poorly tolerated during pregnancy. Women with tetralogy of fallot should be treated before trying to conceive. Because of the decrease in systemic vascular resistance, right-left shunt becomes worse during pregnancy. Women with Eisenmenger syndrome have a 30-50% risk of maternal mortality during pregnancy. Therefore, these high-risk women should be discussed methods of contraception or termination of pregnancy.
There are many data on women with fully repaired congenital heart disease who are able to live to adulthood and give birth, they are recommended fetal echocardiography. Fetal echocardiography has the ability to identify prenatal cardiac abnormalities leading to elective termination of pregnancy, thus reducing the incidence of congenital heart disease.

Women should be advised about warfarin and statins that are not currently used during pregnancy. ACE inhibitors, receptor blockers, atenolol and amiodarone are class D. Unfractionated heparin and low molecular weight heparin should be substituted for warfarin during some of the above stages of pregnancy. Hydralazine and nitrate are used as an alternative to ACE inhibitors/receptor blockers in patients with heart failure. ACE inhibitors can be used in lactating women. Metoprolol, propranolol or labetalol should be used or given atenolol. For patients with cardiovascular disease during pregnancy, regular antenatal check-ups are extremely necessary, helping to protect the health of both the mother and the development of the fetus. Currently, Cardiology Center - Vinmec Times City International General Hospital is a specialized cardiology clinic put into operation since March 2019 with leading equipment and technology in Vietnam. If you have a heart condition, you can completely trust the expertise of the doctor and the treatment protocol here. In addition, Vinmec International General Hospital also offers a maternity package that takes care of pregnant women and their babies from pregnancy to labor.