『Cardiology - Cardiomyopathies in Pregnancy』のカバーアート

Cardiology - Cardiomyopathies in Pregnancy

Cardiology - Cardiomyopathies in Pregnancy

無料で聴く

ポッドキャストの詳細を見る

このコンテンツについて

 Cardiovascular DiseaseExecutive SummaryThis briefing document summarizes key information regarding cardiovascular health during pregnancy, drawing insights from "Pregnancy and Cardiovascular Disease - Cardiovascular Medicine Text - MKSAP 19.pdf". It highlights the increasing maternal mortality in the US due to cardiovascular disorders, the physiological changes during normal pregnancy, and the critical importance of prepregnancy evaluation, multidisciplinary management, and careful consideration of medication and anticoagulation therapies for women with pre-existing or pregnancy-related cardiovascular conditions. Special attention is given to high-risk conditions like peripartum cardiomyopathy and Marfan syndrome.I. Maternal Mortality Trends and Primary CausesMaternal mortality in the United States has increased over the past two decades, a trend contrasting with decreasing rates in other Western countries. The leading cause of maternal mortality is acquired cardiovascular disorders, specifically "cardiomyopathy, coronary artery disease, and aortic disorders."II. Cardiovascular Changes During Normal PregnancyUnderstanding normal physiological changes is crucial for distinguishing between healthy and pathologic signs. Key cardiovascular adaptations during a normal pregnancy include:Relative Anemia: Due to a greater increase in plasma volume compared to erythrocyte mass.Decreased Mean Arterial Pressure: Resulting from "reduced systemic vascular resistance and increased heart rate and cardiac output."Increased Heart Rate and Cardiac Output: Maternal cardiac output "peaks at approximately 40% to 50% above the prepregnancy level by the 32nd week," and can further increase to "as much as 80% above the prepregnancy level" during delivery.Common Normal Symptoms/Signs: Mild dyspnea, dyspnea with exertion, atrial and ventricular premature beats, heart rate increased by 20-30%, modest blood pressure decrease (~10 mm Hg), and a "basal systolic murmur grade 1/6 or 2/6 present in 80% of pregnant patients, S3."Table 45 (Normal Versus Pathologic Signs and Symptoms in Pregnancy) provides a detailed comparison, distinguishing normal physiological changes from symptoms like orthopnea, chest pain, atrial fibrillation, heart rate >100/min, high blood pressure (≥140/90 mm Hg), systolic murmur grade ≥3/6, or any diastolic murmur/S4, which are considered pathologic.III. Prepregnancy Evaluation and Risk StratificationMandatory Prepregnancy Counseling: "All women with cardiovascular disease should receive pregnancy counseling," including genetic counseling and testing if appropriate. Multidisciplinary Approach: A comprehensive evaluation involving a "cardiologist, a maternal-fetal medicine specialist, and an obstetric anesthesiologist" is essential to assess risks and formulate a management plan for labor and postpartum. Risk Assessment Tool: The modified World Health Organization pregnancy risk classification is currently the "most accurate system of risk assessment."A. Low-Risk ConditionsWomen with certain conditions generally experience no increased morbidity or mortality:Uncomplicated small patent ductus arteriosusMild pulmonary stenosisMitral valve prolapseSuccessfully repaired simple lesions (atrial or ventricular septal defect, patent ductus arteriosus, anomalous pulmonary venous drainage)Isolated atrial or ventricular ectopic beatsTetralogy of Fallot, most supraventricular arrhythmias, and Turner syndrome without aortic dilatation. These patients can typically be managed and deliver in a local hospital.B. Extremely High-Risk Conditions (Require Expert Center Care)Conditions conferring "extremely high risk for maternal mortality or severe morbidity" necessitate care and delivery at "an expert center for pregnancy and cardiac disease":Pulmonary hypertensionPrevious peripartum cardiomyopathy with residual left ventricular dysfunctionSevere left ventricular dysfunction (ejection fraction <30% or NYHA functional class III-IV symptoms)Severe mitral stenosisSymptomatic severe aortic stenosisMarked ascending aorta dilatationIV. Management of Cardiovascular Disease During PregnancyA. Valvular LesionsObstructive: Symptoms may arise due to increased blood volume/cardiac output; intervention before pregnancy should be considered.Regurgitant: Generally well-tolerated during pregnancy.B. Hypertrophic CardiomyopathySymptomatic obstructive hypertrophic cardiomyopathy: Treated with "nonvasodilating β-blockers, with monitoring of fetal growth."C. ArrhythmiasMost arrhythmias are benign.Shared decision-making is crucial for antiarrhythmic drugs, considering maternal and fetal risks/benefits.Most β-blockers (except atenolol) are safe for pregnancy and breastfeeding.Adenosine is the drug of choice for acute symptomatic supraventricular tachycardia.Amiodarone is rarely used due to toxicity.D. Delivery MethodVaginal delivery is generally preferred due to "less blood loss, quicker recovery, and lower risk for thrombosis."Cesarean delivery...
まだレビューはありません