Hypertrophic cardiomyopathy management during pregnancy: Difference between revisions

Jump to navigation Jump to search
Line 23: Line 23:
Although both [[beta blockers]] and [[verapamil]] may improve symptoms in the mother, the dosing should be limited to minimize the risk of fetal [[bradycardia]], [[growth retardation]] and [[hypoglycemia]]. There is more experience with the use [[beta blockers]] during pregnancy.
Although both [[beta blockers]] and [[verapamil]] may improve symptoms in the mother, the dosing should be limited to minimize the risk of fetal [[bradycardia]], [[growth retardation]] and [[hypoglycemia]]. There is more experience with the use [[beta blockers]] during pregnancy.


==Epidural Anesthesia Should Be Avoided==
 
Due to the potential for venous pooling, <u>'''''epidural anesthesia should be avoided.'''''</u>. Blood should be crossed and typed in case a transfusion is needed for bleeding, which can exacerbate outflow obstruction.


==Home Delivery Should Be Avoided==
==Home Delivery Should Be Avoided==

Revision as of 03:08, 8 August 2011

Hypertrophic Cardiomyopathy Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hypertrophic Cardiomyopathy from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Interventions

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Hypertrophic cardiomyopathy management during pregnancy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Hypertrophic cardiomyopathy management during pregnancy

CDC on Hypertrophic cardiomyopathy management during pregnancy

Hypertrophic cardiomyopathy management during pregnancy in the news

Blogs on Hypertrophic cardiomyopathy management during pregnancy

Directions to Hospitals Treating Hypertrophic cardiomyopathy

Risk calculators and risk factors for Hypertrophic cardiomyopathy management during pregnancy

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

Overview

Women with hypertrophic cardiomyopathy should be managed by a skilled cardiovascular specialist and a high-risk obstetrician during pregnancy. Any activity, drug or circumstance that increases left ventricular outflow obstruction, reduced left ventricular filling, or increases left ventricular afterload should be avoided.

Natural History, Complications And Prognosis In The Hypertrophic Cardiomyopathy Patient During Pregnancy

Among HCM patients who chronically have mild symptoms, pregnancy is generally well tolerated [1][2]. Although pregnancy causes vasodilation which should exacerbate the outflow gradient, pregnancy also causes fluid retention and an increase in plasma volume which increases preload and offsets the reduction in afterload. In a series of 100 HCM patients, only one of 28 asymptomatic patients developed NYHA Class III or IV heart failure. Among 12 previously symptomatic patients, 5 patients developed NYHA Class III or IV heart failure. It is notable that two sudden deaths occurred in this series of 100 patients. One of the two patients had a resting gradient of 115 mm Hg. The other patient had a markedly positive family history with 8 family members sustaining any early death, 5 of which were sudden death [2].

Avoid Activities That Increase Left Ventricular Outflow Tract Obstruction

The following activities increase left ventricular outflow tract obstruction and should be avoided:

Avoid Activities That Increase Afterload

The following activities increase left ventricular afterload should be avoided:

  • Intense isometric exercise

Beta Blockade and Calcium Channel Blockade

Although both beta blockers and verapamil may improve symptoms in the mother, the dosing should be limited to minimize the risk of fetal bradycardia, growth retardation and hypoglycemia. There is more experience with the use beta blockers during pregnancy.


Home Delivery Should Be Avoided

Home delivery without IV access is not preferred.

Vaginal Delivery Versus C-Section

Vaginal delivery is usually successful.

References

  1. Oakley GD, McGarry K, Limb DG, Oakley CM (1979). "Management of pregnancy in patients with hypertrophic cardiomyopathy". British Medical Journal. 1 (6180): 1749–50. PMC 1599373. PMID 572730. Unknown parameter |month= ignored (help)
  2. 2.0 2.1 Autore C, Conte MR, Piccininno M, Bernabò P, Bonfiglio G, Bruzzi P, Spirito P (2002). "Risk associated with pregnancy in hypertrophic cardiomyopathy". Journal of the American College of Cardiology. 40 (10): 1864–9. PMID 12446072. Unknown parameter |month= ignored (help)