Cardiovascular disease in pregnancy
Cardiovascular disease ranks fourth (after infection, toxemia, and hemorrhage) among the leading causes of maternal death. The physiologic stress of pregnancy and delivery is sometimes more than a compromised heart can tolerate and commonly leads to maternal and fetal death.
Between 1% and 2% of pregnant women have cardiac disease, but the incidence is rising because medical treatment today allows more females with rheumatic heart disease and congenital defects to reach childbearing age.
With careful management, the prognosis for the pregnant patient with cardiovascular disease is good. Decompensation is the leading cause of maternal death. Infant mortality increases with decompensation because uterine congestion, insufficient oxygenation, and the elevated carbon dioxide content of the blood not only compromise the fetus but may also cause premature labor and delivery.
Causes
Rheumatic heart disease is present in more than 80% of patients who develop cardiovascular complications. In the rest, these complications stem from congenital defects (10% to 15%) and coronary artery disease (2%).
The diseased heart is sometimes unable to meet the normal demands of pregnancy: a 25% increase in cardiac output, a 40% to 50% increase in plasma volume, increased oxygen requirements, retention of salt and water, weight gain, and alterations in hemodynamics during delivery. This physiologic stress commonly leads to the heart’s failure to maintain adequate circulation (decompensation).
The degree of decompensation depends on the patient’s age, the duration of cardiac disease, and the functional capacity of the heart at the outset of pregnancy.
Signs and symptoms
Typical signs and symptoms of cardiovascular disease in pregnancy include neck vein distention, diastolic murmurs, moist basilar pulmonary crackles, cardiac enlargement (discernible on percussion or as a cardiac shadow on a chest X-ray), and cardiac arrhythmias (other than sinus or paroxysmal atrial tachycardia). Other characteristic abnormalities include cyanosis, pericardial friction rub, pulse delay, and alternating pulse.
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