Cardiac disease in pregnancy and drug therapy

Jump to navigation Jump to search

Cardiac disease in pregnancy Microchapters

Home

Overview

Pathophysiology

Epidemiology and Demographics

Risk Factors

Diagnosis

History and Symptoms

Physical Examination

Electrocardiogram

Exercise Testing

Radiation Exposure

Chest X Ray

Echocardiography

MRI

CT

Catheterization:

Pulmonary artery catheterization
Cardiac catheterization
Cardiac Ablation

Treatment

Cardiovascular Drugs in Pregnancy

Labor and delivery

Resuscitation in Late Pregnancy

Contraindications to pregnancy

Special Scenarios:

I. Pre-existing Cardiac Disease:
Congenital Heart Disease
Repaired Congenital Heart Disease
Pulmonary Hypertension
Rheumatic Heart Disease
Connective Tissue Disorders
II. Valvular Heart Disease:
Mitral Stenosis
Mitral Regurgitation
Aortic Insufficiency
Aortic Stenosis
Mechanical Prosthetic Valves
Tissue Prosthetic Valves
III. Cardiomyopathy:
Dilated Cardiomyopathy
Hypertrophic Cardiomyopathy
Peripartum Cardiomyopathy
IV. Cardiac diseases that may develop During Pregnancy:
Arrhythmias
Acute Myocardial Infarction
Hypertension

Cardiac disease in pregnancy and drug therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Cardiac disease in pregnancy and drug therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Cardiac disease in pregnancy and drug therapy

CDC on Cardiac disease in pregnancy and drug therapy

Cardiac disease in pregnancy and drug therapy in the news

Blogs on Cardiac disease in pregnancy and drug therapy

Directions to Hospitals Treating Cardiac disease in pregnancy

Risk calculators and risk factors for Cardiac disease in pregnancy and drug therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

ACE inhibitors, Angiotensin receptor blockers (ARBss), aldosterone antagonists and warfarin should be avoided in pregnancy.

Cardiovascular Drugs that are Contraindicated During Pregnancy

Cardiovascular Drugs to be Avoided or Used with Caution During Pregnancy

  • Greatest experience in massive pulmonary embolism
  • Streptokinase does not cross placental membrane in animals, but Ab found in neonatal spinal cord fluid
  • Urokinase not teratogenic in mice/rats
  • Risk for maternal hemorrhage (1 case of placental abruption reported); increased risk when given at time of delivery
  • Delivery best delayed at least 2-3 weeks
  • Warfarin is teratogenic but is often required in patients with a mechanical heart valve during pregnancy. There is an increased magnitude of anticoagulation in the fetus compared with the mother because the synthesis of vitamin K dependent co-factors is reduced in the fetal liver. The risks of warfarin use should be discussed with the parents and include retroplacental bleeding, intracranial bleeding in the fetus, fetal loss, and premature birth. Warfarin is a better choice for the mother as it reduces the risk of fatal prosthetic valve thrombosis, but is not safe for the fetus for the reasons listed above. The risk of embryopathy (4%-10%) is highest with exposure from weeks 6 to 12, and is increased as the dose of warfarin is increased above 5 mg.

Cardiovascular Drugs that are Acceptable During Pregnancy

References

  1. Eliahou HE, Silverberg DS, Reisin E, Romem I, Mashiach S, Serr DM. Propranolol for the treatment of hypertension in pregnancy. Br J Obstet Gynaecol 1978;85:431-6.
  2. Lydakis C, Lip GY, Beevers M, Beevers DG. Atenolol and fetal growth in pregnancies complicated by hypertension. Am J Hypertens 1999; 12:541-7.

Template:WH Template:WS CME Category::Cardiology