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Pregnancy and Heart Disease

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Handbook of Outpatient Cardiology

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Abstract

Pregnancy and labor present unique challenges to the maternal cardiovascular system. Pre-existing cardiac diseases, or cardiac diseases that occur during pregnancy, are associated with a significant morbidity and mortality risk for both mother and baby. In the United States, cardiovascular disease is the leading cause of maternal death. The burden of cardiac disease in pregnancy is growing in part due to an increase in adult survivors with congenital heart disease seeking pregnancy, coupled with demographic shifts in the age and cardiovascular risk factors of women giving birth. There is widespread consensus that the best obstetric and neonatal outcomes in women with cardiac disease are delivered by a strategy of carefully coordinated multidisciplinary care, beginning in the pre-pregnancy outpatient setting. This chapter will summarize some of the key issues faced in relation to the diagnosis, treatment, and health service delivery in this patient group and includes suggested priorities for the outpatient primary care provider.

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Abbreviations

ACS:

Acute coronary syndrome

ACOG:

American College of Obstetricians and Gynecologists

CV:

Cardiovascular

CHD:

Coronary heart disease

HF:

Heart failure

HCM:

Hypertrophic cardiomyopathy

LV:

Left ventricular

PPCM:

Peripartum cardiomyopathy

VHD:

Valvular heart disease

VT:

Ventricular tachycardia

References

  1. Mehta LS, Warnes CA, Bradley E, Burton T, Economy K, Mehran R, et al. Cardiovascular considerations in caring for pregnant patients: A scientific statement from the American Heart Association. Circulation. 2020;141(23):e884–903.

    Article  PubMed  Google Scholar 

  2. Grodzinsky A, Florio K, Spertus JA, Daming T, Lee J, Rader V, et al. Importance of the cardio-obstetrics team. Curr Treat Options Cardiovasc Med. 2019;21(12):84.

    Article  PubMed  Google Scholar 

  3. Committee Opinion No. 723. Guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol. 2017;130(4):e210–e6.

    Article  Google Scholar 

  4. Hypertension in pregnancy. Report of the American college of obstetricians and gynecologists’ task force on hypertension in pregnancy. Obstet Gynecol. 2013;122(5):1122–31.

    Google Scholar 

  5. Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ. 2007;335(7627):974.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ghossein-Doha C, van Neer J, Wissink B, Breetveld NM, de Windt LJ, van Dijk AP, et al. Pre-eclampsia: an important risk factor for asymptomatic heart failure. Ultrasound Obstet Gynecol. 2017;49(1):143–9.

    Article  CAS  PubMed  Google Scholar 

  7. Theilen LH, Meeks H, Fraser A, Esplin MS, Smith KR, Varner MW. Long-term mortality risk and life expectancy following recurrent hypertensive disease of pregnancy. Am J Obstet Gynecol. 2018;219(1):107.e1–e6.

    Google Scholar 

  8. Wu P, Haththotuwa R, Kwok CS, Babu A, Kotronias RA, Rushton C, et al. Preeclampsia and future cardiovascular health. Circ Cardiovasc Qual Outcomes. 2017;10(2):e003497.

    Article  PubMed  Google Scholar 

  9. Al-Balas M, Bozzo P, Einarson A. Use of diuretics during pregnancy. Can Fam Physician. 2009;55(1):44–5.

    PubMed  PubMed Central  Google Scholar 

  10. Cooper WO, Hernandez-Diaz S, Arbogast PG, Dudley JA, Dyer S, Gideon PS, et al. Major congenital malformations after first-trimester exposure to ACE inhibitors. N Engl J Med. 2006;354(23):2443–51.

    Article  CAS  PubMed  Google Scholar 

  11. Canobbio MM, Warnes CA, Aboulhosn J, Connolly HM, Khanna A, Koos BJ, et al. Management of Pregnancy in patients with complex congenital heart Disease: A scientific statement for healthcare professionals from the American Heart Association. Circulation. 2017;135(8):e50–87.

    Article  PubMed  Google Scholar 

  12. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, et al. ACC/AHA 2008 guidelines for the Management of Adults with congenital heart Disease: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation. 2008;118(23):e714–833.

    PubMed  Google Scholar 

  13. Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, Foidart JM, et al. ESC guidelines on the management of cardiovascular diseases during pregnancy: the task force on the Management of Cardiovascular Diseases during pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(24):3147–97.

    Article  PubMed  Google Scholar 

  14. Elkayam U, Goland S, Pieper PG, Silverside CK. High-risk cardiac Disease in pregnancy: part I. J Am Coll Cardiol. 2016;68(4):396–410.

    Article  PubMed  Google Scholar 

  15. Sliwa K, Hilfiker-Kleiner D, Petrie MC, Mebazaa A, Pieske B, Buchmann E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the heart failure Association of the European Society of cardiology working group on peripartum cardiomyopathy. Eur J Heart Fail. 2010;12(8):767–78.

    Article  PubMed  Google Scholar 

  16. Elkayam U. Clinical characteristics of peripartum cardiomyopathy in the United States: diagnosis, prognosis, and management. J Am Coll Cardiol. 2011;58(7):659–70.

    Article  PubMed  Google Scholar 

  17. Elkayam U, Akhter MW, Singh H, Khan S, Bitar F, Hameed A, et al. Pregnancy-associated cardiomyopathy: clinical characteristics and a comparison between early and late presentation. Circulation. 2005;111(16):2050–5.

    Article  PubMed  Google Scholar 

  18. Arrigo M, Blet A, Mebazaa A. Bromocriptine for the treatment of peripartum cardiomyopathy: welcome on BOARD. Eur Heart J. 2017;38(35):2680–2.

    Article  PubMed  Google Scholar 

  19. Codsi E, Rose CH, Blauwet LA. Subsequent pregnancy outcomes in patients with Peripartum cardiomyopathy. Obstet Gynecol. 2018;131(2):322–7.

    Article  PubMed  Google Scholar 

  20. Sen-Chowdhry S, Jacoby D, Moon JC, McKenna WJ. Update on hypertrophic cardiomyopathy and a guide to the guidelines. Nat Rev Cardiol. 2016;13(11):651–75.

    Article  CAS  PubMed  Google Scholar 

  21. Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. J Thorac Cardiovasc Surg. 2011;142(6):e153–203.

    Article  PubMed  Google Scholar 

  22. Members ATF, Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, et al. 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(39):2733–79.

    Article  Google Scholar 

  23. Maron BJ, Maron MS. Hypertrophic cardiomyopathy. Lancet. 2013;381(9862):242–55.

    Article  PubMed  Google Scholar 

  24. Richard P, Charron P, Carrier L, Ledeuil C, Cheav T, Pichereau C, et al. Hypertrophic cardiomyopathy. Circulation. 2003;107(17):2227–32.

    Article  PubMed  Google Scholar 

  25. Maron MS, Rowin EJ, Maron BJ. How to image hypertrophic cardiomyopathy. Circ Cardiovasc Imaging. 2017;10(7):e005372.

    Article  PubMed  Google Scholar 

  26. Tanaka H, Kamiya C, Katsuragi S, Tanaka K, Miyoshi T, Tsuritani M, et al. Cardiovascular events in pregnancy with hypertrophic cardiomyopathy. Circ J. 2014;78(10):2501–6.

    Article  PubMed  Google Scholar 

  27. Goland S, van Hagen IM, Elbaz-Greener G, Elkayam U, Shotan A, Merz WM, et al. Pregnancy in women with hypertrophic cardiomyopathy: data from the European Society of Cardiology initiated registry of pregnancy and cardiac disease (ROPAC). Eur Heart J. 2017;38(35):2683–90.

    Article  CAS  PubMed  Google Scholar 

  28. Lima FV, Parikh PB, Zhu J, Yang J, Stergiopoulos K. Association of cardiomyopathy with adverse cardiac events in pregnant women at the time of delivery. JACC Heart Fail. 2015;3(3):257–66.

    Article  PubMed  Google Scholar 

  29. Gibson P, Narous M, Firoz T, Chou D, Barreix M, Say L, et al. Incidence of myocardial infarction in pregnancy: a systematic review and meta-analysis of population-based studies. Eur Heart J Qual Care Clin Outcomes. 2017;3(3):198–207.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Elkayam U, Jalnapurkar S, Barakkat MN, Khatri N, Kealey AJ, Mehra A, et al. Pregnancy-associated acute myocardial infarction: a review of contemporary experience in 150 cases between 2006 and 2011. Circulation. 2014;129(16):1695–702.

    Article  PubMed  Google Scholar 

  31. Colletti PM, Lee KH, Elkayam U. Cardiovascular imaging of the pregnant patient. AJR Am J Roentgenol. 2013;200(3):515–21.

    Article  PubMed  Google Scholar 

  32. Jeejeebhoy FM, Zelop CM, Lipman S, Carvalho B, Joglar J, Mhyre JM, et al. Cardiac arrest in pregnancy: A scientific statement from the American Heart Association. Circulation. 2015;132(18):1747–73.

    Article  PubMed  Google Scholar 

  33. Chernoguz A, Telem DA, Chu E, Ozao-Choy J, Tammaro Y, Divino CM. Cessation of clopidogrel before major abdominal procedures. Arch Surg. 2011;146(3):334–9.

    Article  CAS  PubMed  Google Scholar 

  34. Bernal JM, Miralles PJ. Cardiac surgery with cardiopulmonary bypass during pregnancy. Obstet Gynecol Surv. 1986;41(1):1–6.

    Article  CAS  PubMed  Google Scholar 

  35. Sundaram V, Chaudhry SP, Reddy YN, Longenecker CT, Fang JC. Emergent cesarean section in the catheterization laboratory for spontaneous coronary artery dissection. Am J Cardiol. 2015;115(12):1777–8.

    Article  PubMed  Google Scholar 

  36. Vaidya VR, Arora S, Patel N, Badheka AO, Patel N, Agnihotri K, et al. Burden of arrhythmia in pregnancy. Circulation. 2017;135(6):619–21.

    Article  PubMed  Google Scholar 

  37. Enriquez AD, Economy KE, Tedrow UB. Contemporary management of arrhythmias during pregnancy. Circ Arrhythm Electrophysiol. 2014;7(5):961–7.

    Article  PubMed  Google Scholar 

  38. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, et al. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165–241.

    Article  PubMed  Google Scholar 

  39. Wang YC, Chen CH, Su HY, Yu MH. The impact of maternal cardioversion on fetal haemodynamics. Eur J Obstet Gynecol Reprod Biol. 2006;126(2):268–9.

    Article  PubMed  Google Scholar 

  40. Agewall S, Camm J. New ESC/EACTS guidelines for the management of atrial fibrillation. Eur Heart J Cardiovasc Pharmacother. 2017;3(2):71–2.

    Article  PubMed  Google Scholar 

  41. Lau E, DeFaria Yeh D. Management of high risk cardiac conditions in pregnancy: anticoagulation, severe stenotic valvular disease and cardiomyopathy. Trends Cardiovasc Med. 2019;29(3):155–61.

    Article  PubMed  Google Scholar 

  42. Halpern DG, Weinberg CR, Pinnelas R, Mehta-Lee S, Economy KE, Valente AM. Use of medication for cardiovascular disease during pregnancy: JACC state-of-the-art review. J Am Coll Cardiol. 2019;73(4):457–76.

    Article  PubMed  Google Scholar 

  43. Rashba EJ, Zareba W, Moss AJ, Hall WJ, Robinson J, Locati EH, et al. Influence of pregnancy on the risk for cardiac events in patients with hereditary long QT syndrome. LQTS Investigat Circulat. 1998;97(5):451–6.

    Article  CAS  Google Scholar 

  44. Elkayam U. Native valvular heart disease and pregnancy. In: Cardiac problems in pregnancy; 2019. p. 75–89.

    Chapter  Google Scholar 

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Acknowledgments

We would like to acknowledge the support of the Byron William Jr., MD Fellowship Fund.

Author information

Authors and Affiliations

  1. Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA

    Mariana Garcia, An Young & Gina Lundberg

Authors
  1. Mariana Garcia
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  2. An Young
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  3. Gina Lundberg
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Corresponding author

Correspondence to Mariana Garcia .

Editor information

Editors and Affiliations

  1. Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA

    Ankit A. Bhargava

  2. Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA

    Bryan J. Wells

  3. Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Pablo A. Quintero

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Garcia, M., Young, A., Lundberg, G. (2022). Pregnancy and Heart Disease. In: Bhargava, A.A., Wells, B.J., Quintero, P.A. (eds) Handbook of Outpatient Cardiology . Springer, Cham. https://doi.org/10.1007/978-3-030-88953-1_29

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  • DOI: https://doi.org/10.1007/978-3-030-88953-1_29

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