DEPARTMENT OF NURISNG UNIVERSITY OF IBADAN

TITLE: CARDIOVASCULAR DISEASES IN PREGNANCY

BY: GROUP 1

COURSE CODE: NSG 414

COURSE TITLE: MIDWIFERY III

LECTURER-IN-CHARGE: MRS OJO

JULY 2024
 GROUP MEMBERS
S/N NAME MATRIC NUMBER
1 ABDULAZEEZ ABDULSAMAD ADESINA 220687
2 ADERINTO TAOFIKAT OMOTOYOSI 220696
3 MARUFF KEREEMOT OLOLADE 220621
4 IBEKWE KELECHI GEMMA 190795
5 OKUNOLA AMINAT MOSOPEFOLUWA 149005
 INTRODUCTION
Cardiac disease is an uncommon but potentially serious medical complication of pregnancy.
Cardiac / cardiovascular diseases are heart conditions that include diseased vessels, structural
problems and blood clots. The incidence of heart disease in pregnancy ranges from 0.3% to
3.5%. (Lotgering, 1994). Cardiovascular disease (CVD) is a significant health concern during
pregnancy, affecting both the mother and the developing fetus. It is a leading cause of maternal
mortality and morbidity worldwide, with the risk of CVD increasing significantly during
pregnancy (American Heart Association, 2020). This increased risk is due to the physiological
changes that occur during pregnancy, which can exacerbate underlying cardiovascular conditions
or lead to new cardiovascular complications (American College of Obstetricians and
Gynecologists, 2019).
Cardiovascular physiology and pregnancy.
Hormonally mediated increases in blood volume, red cell mass, and heart rate result in a major
increase in cardiac output during pregnancy; cardiac output peaks during the second trimester,
and remains constant until term. Gestational hormones, circulating prostaglandins, and the low
resistance vascular bed in the placenta result in concomitant decreases in peripheral vascular
resistance and blood pressure. During labour and delivery, pain and uterine contractions result in
additional increases in cardiac output and blood pressure. Immediately following delivery, relief
of caval compression and autotransfusion from the emptied and contracted uterus produce a
further increase in cardiac output.

IMPORTANCE OF UNDERSTANDING CARDIAC DISEASES IN PREGNANCY

1. Early detection and management: By understanding the types of cardiac disease and
their potential risks during pregnancy, doctors can identify women at risk early on. This
allows for pre-pregnancy counseling, close monitoring throughout pregnancy, and
adjustments to medications or delivery plans to optimize both mother and baby's health.
2. Reduced pregnancy complications: Many cardiac conditions put extra strain on the
heart during pregnancy, which can lead to complications like pre-eclampsia, heart failure,
and preterm birth .Recognizing the signs and risk factors allows for proactive
management to minimize these complications.
 3. Improved pregnancy management: With an understanding of the specific cardiac
condition, doctors can tailor a pregnancy management plan for each woman. This may
involve medication adjustments, more frequent prenatal visits, and collaboration with
cardiologists to ensure optimal care throughout pregnancy.

List of some cardiac diseases that can occur in pregnant women due to the effects of the
fetus and the physiological changes of pregnancy
1. Peripartum Cardiomyopathy (PPCM)
2. Hypertensive Disorders of Pregnancy e.g Preeclampsia, Eclampsia, Gestational
Hypertension
3. Arrhythmias e.g Atrial Fibrillation, Atrial Flutter, Ventricular Tachycardia,
4. Peripartum Aortic Dissection,
5. Pregnancy-Related Myocardial Infarction (Heart Attack)
6. Heart Failure (which can occur as an exacerbation of pre-existing heart conditions)
7. Pulmonary Edema (Often secondary to preeclampsia or heart failure)
8. Aortic Stenosis (that can be exacerbated by increased blood volume)
9. Marfan Syndrome Complications (Increased risk of aortic dissection due to connective
tissue disorder)
10. Thromboembolism (Increased risk of blood clots due to hypercoagulable state of
pregnancy)
11. Ischemic Heart Disease (Reduced blood flow to the heart muscle)
12. Ebstein's Anomaly
13. Rheumatic Heart Disease (Can be exacerbated by pregnancy due to increased cardiac
workload)
14. Pericarditis (Inflammation of the pericardium, often due to autoimmune conditions
exacerbated by pregnancy)
15. Takotsubo Cardiomyopathy (Stress-induced cardiomyopathy, sometimes triggered by the
stress of pregnancy and childbirth)

PERIPARTUM CARDIOMYOPATHY
Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy that presents with heart
failure secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the
months after delivery, in the absence of any other cause of heart failure (Hoes et al, 2022).

Pathophysiology
The exact cause of PPCM remains unknown but is likely multifactorial (Hilfiker-Kleiner &
Sliwa, 2014). Recent research has focused on the "vasculo-hormonal hypothesis" with soluble
Fms-like tyrosine kinase 1 (sFlt1) and prolactin as molecules involved in the pathophysiology
(Zolt & Arany, 2024). Increased reactive oxygen species lead to secretion of cathepsin D, which
cleaves prolactin into a 16kDa fragment. 16kDa prolactin induces endothelial cells to package
miR-146 into exosomes, which are then taken up by cardiomyocytes, leading to endothelial and
myocyte apoptosis (Hilfiker-Kleiner & Sliwa, 2014). sFlt1, secreted by the placenta in late
gestation, neutralizes vascular endothelial growth factor (VEGF), reducing circulating VEGF
which is thought to contribute to PPCM (Karen et al, 2010).
Risk factors
1. Older age
2. Black ethnicity
3. Multiparity
4. Pre-eclampsia
5. Hypertension
6. Smoking
7. Malnutrition.

Signs and Symptoms

Shortness of breath
Fatigue,
Leg edema.
Treatment and Management
Management involves guideline-directed pharmacological therapy for heart failure with reduced
ejection fraction, respecting contraindications in pregnancy. Blocking prolactin is a potential
therapeutic target. Delivery is indicated if the maternal condition deteriorates despite medical
therapy (Zolt & Arany, 2024).
Complications
Maternal complications include hypoxia, thromboembolism, arrhythmias, and sudden cardiac
death. Long-term morbidity and mortality are not infrequent, but many women recover cardiac
function.
PERIPARTUM AORTIC DISSECTION
Peripartum aortic dissection is a rare but life-threatening condition characterized by a tear in the
inner layer of the aorta, the large blood vessel branching off the heart. This tear allows blood to
flow between the layers of the aortic wall, causing the layers to separate (dissect). Pregnancy-
related hormonal changes, increased blood volume, and heightened cardiac output can weaken
the aortic wall, making it more susceptible to dissection
Pathophysiology and Causes
The pathophysiology of peripartum aortic dissection is multifactorial, involving both
hemodynamic and structural changes during pregnancy ( Silvestri, Mazzesi, & Mele, 2019).
Pregnancy leads to increased blood volume, cardiac output, and sympathetic activity, which can
increase shear stress on the aortic wall. Hormonal changes during pregnancy may also affect the
integrity of the aortic wall. Underlying aortopathies such as Marfan syndrome, Loeys-Dietz
syndrome, and bicuspid aortic valve significantly increase the risk of aortic dissection during
pregnancy. Hypertensive disorders of pregnancy, including preeclampsia, may also trigger aortic
dissection at relatively small aortic diameters(Braveman et al, 2021).
Signs and Symptoms
Sudden, severe chest, back, or abdominal pain
Shortness of breath
Hypotension or shock
Neurological deficits
Signs of aortic regurgitation (e.g. bounding pulses, wide pulse pressure)
Treatment and Management
Management
Prompt diagnosis using imaging studies like CT angiography
Blood pressure control with antihypertensive medications
Surgical repair or endovascular intervention, depending on the type and location of dissection
Delivery of the fetus if the maternal condition deteriorates despite medical therapy
Complications
Potential complications of peripartum aortic dissection include:
Maternal mortality, which has been reported in up to 25% of cases
Aortic rupture or retrograde dissection
Malperfusion syndromes affecting the brain, kidneys, or limbs
Aortic regurgitation
Cardiac tamponade
PREGNANCY-RELATED MYOCARDIAL INFARCTION (HEART ATTACK)
Pregnancy-related myocardial infarction (MI) occurs when blood flow to a part of the heart
muscle is blocked, leading to tissue damage or necrosis. During pregnancy, physiological
changes such as increased blood volume, cardiac output, and a hypercoagulable state can
increase the risk of MI. Additionally, hormonal changes can contribute to endothelial
dysfunction and coronary artery vasospasm, further raising the risk.
Pathophysiology and Causes
The pathophysiology of pregnancy-related acute myocardial infarction (AMI) is similar to non-
pregnant patients, but with some key differences Pregnancy is associated with a hypercoagulable
state, increased blood volume, and higher cardiac output, all of which can increase the risk of
thrombosis and plaque rupture. Spontaneous coronary artery dissection (SCAD) is a leading
cause of AMI in pregnancy, particularly in the peripartum period. SCAD is thought to be
triggered by the hormonal and hemodynamic changes of pregnancy. Other causes include
atherosclerotic plaque rupture, coronary vasospasm, and embolism. Underlying risk factors like
advanced maternal age, hypertension, diabetes, and smoking also contribute to the increased
AMI risk during pregnancy.
Signs and Symptoms
The presentation of pregnancy-related AMI can be atypical, with symptoms like chest pain,
shortness of breath, nausea, and back pain. Myocardial infarction should be suspected in any
pregnant woman presenting with chest pain or angina equivalents.
Treatment and Management
1. Management is similar to non-pregnant patients, with early revascularization
(percutaneous coronary intervention or coronary artery bypass grafting) for high-risk
features.
 2. Antithrombotic therapy with aspirin and anticoagulants must balance maternal and fetal
risks. Thrombolytic therapy has limited data in pregnancy due to increased risk of
maternal hemorrhage, and is generally considered a relative contraindication.
3. Medications like beta-blockers and nitrates can be used cautiously, considering fetal
effects.
4. Delivery of the fetus may be indicated in some cases if the maternal condition
deteriorates despite medical therapy.

Complications
Pregnancy-related AMI is associated with high maternal and fetal mortality, with over 50% of
cases resulting in adverse outcomes. Complications include
1. Cardiogenic shock
2. Heart failure
3. Arrhythmias
4. Death for the mother
5. Preterm birth
6. Fetal death.
7. Long-term sequelae for the mother include increased risk of future cardiovascular events.

HYPERTENSIVE DISORDERS OF PREGNANCY

Hypertensive disorders of pregnancy are a group of conditions characterized by high blood
pressure that develop during pregnancy. They include pre-eclampsia, eclampsia, gestational
hypertension.
Gestational Hypertension
Pathophysiology
Gestational hypertension is new-onset hypertension after 20 weeks of gestation without
proteinuria or other systemic signs of preeclampsia. It is thought to be due to the increased
cardiovascular demand during pregnancy and can sometimes progress to preeclampsia.
Causes
1. Unknown Etiology: Exact cause is not well understood.
2. Increased Cardiac Output and Blood Volume: Associated with pregnancy.
3. Genetic Predisposition.
 4. Pre-existing Conditions: Such as obesity and diabetes.

Signs and Symptoms

1. Hypertension: Blood pressure ≥140/90 mm Hg on two occasions at least 4 hours apart.
2. No Significant Proteinuria.
3. No Severe Symptoms: Like those seen in preeclampsia.

Treatment and Management

1. Monitoring: Regular blood pressure monitoring and urine tests to detect any progression
to preeclampsia.
2. Lifestyle Modifications: Rest, dietary changes, and physical activity as appropriate.
3. Medication: Antihypertensive medications if blood pressure is significantly elevated.
4. Frequent Prenatal Visits: To monitor the health of the mother and the fetus.

Complications
1. Progression to Preeclampsia.
2. Preterm Birth.
3. Placental Abruption.
4. Fetal Growth Restriction.
5. Increased Risk of Chronic Hypertension: Postpartum

Pre-eclampsia
Pathophysiology:
Preeclampsia is a multi-system disorder characterized by new-onset hypertension and proteinuria
after 20 weeks of gestation. The exact cause is unknown, but it involves abnormal placentation,
endothelial dysfunction, and an exaggerated inflammatory response. The placenta releases
factors that damage maternal endothelial cells, leading to widespread vascular dysfunction and
hypertension.

Causes
1. Abnormal Placentation: Defective implantation of the placenta leads to poor placental
perfusion and the release of anti-angiogenic factors.
2. Genetic Factors: Family history of preeclampsia increases the risk.
3. Immunologic Factors: Abnormal immune response to paternal antigens.
 4. Pre-existing Conditions: Chronic hypertension, diabetes, obesity, and renal disease.

Signs and Symptoms

1. Hypertension: Blood pressure ≥140/90 mm Hg on two occasions at least 4 hours apart.
2. Proteinuria: ≥300 mg of protein in a 24-hour urine collection or protein/creatinine ratio
≥0.3.
3. Edema: Swelling, especially in the hands and face.
4. Severe Headache: Often not relieved by usual painkillers.
5. Visual Disturbances: Blurred vision, flashing lights, or temporary blindness.
6. Epigastric Pain: Pain in the upper right abdomen.
7. Nausea and Vomiting.
8. Oliguria: Reduced urine output.
9. Shortness of Breath: Due to pulmonary edema.

Treatment and Management

1. Blood Pressure Control: Antihypertensive medications (labetalol, nifedipine,
methyldopa).
2. Seizure Prophylaxis: Magnesium sulfate for severe cases.
3. Monitoring: Frequent monitoring of blood pressure, urine protein, liver enzymes, and
platelet count.
4. Delivery: The definitive treatment is delivery of the baby, typically considered after 37
weeks or earlier if severe symptoms develop.
5. Bed Rest and Hospitalization: In severe cases to closely monitor mother and fetus.

Complications
1. Eclampsia: Onset of seizures in a woman with preeclampsia.
2. HELLP Syndrome: Hemolysis, Elevated Liver enzymes, Low Platelet count.
3. Placental Abruption: Premature separation of the placenta.
4. Acute Kidney Injury.
5. Pulmonary Edema.
6. Stroke.
7. Fetal Growth Restriction.
 8. Preterm Birth.

Eclampsia
Pathophysiology
Eclampsia is the occurrence of seizures in a woman with preeclampsia. It is a severe
complication resulting from cerebral edema, endothelial dysfunction, and vascular damage.
These changes can lead to increased intracranial pressure and seizures.
Causes
1. Untreated or Severe Preeclampsia.
2. Vascular Endothelial Damage: Leading to cerebral edema and seizures.
3. Genetic and Environmental Factors: Similar to preeclampsia.

Signs and Symptoms

1. Seizures: Generalized tonic-clonic seizures.
2. Severe Headache.
3. Visual Disturbances.
4. Epigastric Pain.
5. Sudden Increase in Blood Pressure.
6. Confusion or Altered Mental Status.

Treatment and Management

1. Seizure Control: Magnesium sulfate is the drug of choice to prevent and control seizures.
2. Blood Pressure Management: Antihypertensive medications.
3. Monitoring: Continuous monitoring in a high-dependency or intensive care unit.
4. Delivery: Immediate delivery is often necessary, regardless of gestational age, to prevent
further maternal and fetal complications.

Complications
1. Permanent Neurological Damage: Due to prolonged seizures.
2. Cerebral Hemorrhage.
3. Cardiovascular Collapse.
4. Pulmonary Edema.
 5. Kidney Failure.
6. Maternal and Fetal Death.

ARRHYTHMIAS IN PREGNANT WOMEN

During pregnancy, physiological and hormonal changes can predispose women to arrhythmias.
These changes include increased blood volume, elevated cardiac output, and hormonal
fluctuations, which can impact the heart's electrical conduction system, leading to irregular
heartbeats. Examples include, atrial fibrillation, atrial flutter and ventricular tachycardia (Wit &
Rosen, 2023).
1. Atrial Fibrillation (AF)

Pathophysiology in Pregnant Women

Atrial fibrillation involves rapid and irregular electrical impulses in the atria, causing ineffective
atrial contractions and irregular ventricular response. The increased blood volume and cardiac
output during pregnancy can exacerbate these irregularities.
Causes in Pregnant Women
1. Structural Heart Disease: Such as mitral stenosis or hypertrophic cardiomyopathy.
2. Thyroid Dysfunction: Pregnancy-related hyperthyroidism can precipitate AF.
3. Electrolyte Imbalances: Common during pregnancy, such as low potassium or
magnesium.
4. Infection: Increased susceptibility to infections like myocarditis.
5. High Blood Pressure: Pregnancy-induced hypertension can lead to atrial enlargement and
AF.
6. Stress and Hormonal Changes: The physical and emotional stress of pregnancy can
trigger AF.

Signs and Symptoms

1. Palpitations: Sensation of rapid, irregular heartbeat.
2. Fatigue: Exacerbated by increased cardiac workload during pregnancy.
3. Dizziness or Lightheadedness.
4. Shortness of Breath: More pronounced due to increased respiratory demand.
5. Chest Pain: In severe cases.
Treatment and Management in Pregnant Women (Ray, Geier, & DeWitt, 2023).
1. Rate Control: Beta-blockers (e.g., metoprolol) or calcium channel blockers (e.g.,
diltiazem), both generally safe during pregnancy.
2. Rhythm Control: Antiarrhythmic drugs (e.g., flecainide) if necessary and deemed safe.
3. Anticoagulation: Low molecular weight heparin (LMWH) is preferred due to its safety
profile.
4. Monitoring: Frequent monitoring of maternal and fetal well-being, including regular
ECGs and echocardiograms.
5. Lifestyle Modifications: Rest, stress reduction, and avoiding triggers like caffeine and
alcohol.

Complications
1. Thromboembolism: Increased risk of stroke due to blood clots forming in the atria.
2. Heart Failure: Due to inefficient heart pumping, exacerbated by pregnancy.

2. Atrial Flutter
Pathophysiology in Pregnant Women
Atrial flutter is characterized by a rapid but regular atrial rhythm, often due to a reentrant circuit
in the right atrium. Pregnancy-related changes in cardiac electrophysiology can facilitate these
circuits.
Causes in Pregnant Women
1. Structural Heart Disease: Such as mitral valve disease.
2. Previous Cardiac Surgery: Scar tissue can create reentry circuits.
3. Pericarditis: Increased risk during pregnancy.
4. Chronic Lung Disease: Pulmonary hypertension related to pregnancy can lead to right
atrial enlargement and flutter.

Signs and Symptoms

1. Palpitations: Regular but rapid heartbeat.
2. Fatigue and Weakness.
3. Shortness of Breath: More pronounced due to pregnancy-induced increased respiratory
demand.
4. Dizziness or Fainting.
Treatment and Management in Pregnant Women
1. Rate Control: Beta-blockers or calcium channel blockers.
2. Rhythm Control: Cardioversion if indicated and safe, typically after the first trimester.
3. Anticoagulation: LMWH if thromboembolism risk is high.
4. Close Monitoring: Frequent antenatal visits to monitor maternal and fetal health.

Complications
1. Thromboembolism: Increased risk of clot formation.
2. Heart Failure: If the arrhythmia is not controlled.

3. Ventricular Tachycardia (VT)

Pathophysiology in Pregnant Women
Ventricular tachycardia is a rapid heart rhythm originating from the ventricles, often due to
reentrant circuits or enhanced automaticity of ventricular cells. Pregnancy-related hormonal
changes and increased cardiac workload can precipitate VT.
Causes in Pregnant Women
1. Structural Heart Disease: Such as ischemic heart disease or cardiomyopathy.
2. Electrolyte Imbalances: Common during pregnancy, such as hypokalemia or
hypomagnesemia.
3. Myocardial Infarction: Pregnancy increases the risk of heart attack.
4. Congenital Heart Disease: Can be exacerbated by pregnancy.
5. Drug Toxicity: Including antiarrhythmic drugs used during pregnancy.

Signs and Symptoms

1. Palpitations: Rapid heart rate.
2. Dizziness or Lightheadedness.
3. Chest Pain or Discomfort.
4. Syncope: Fainting due to decreased cardiac output.
5. Shortness of Breath: Exacerbated by increased respiratory demand during pregnancy.

Treatment and Management in Pregnant Women

1. Immediate Management: Intravenous antiarrhythmics (e.g., lidocaine, amiodarone) if
necessary and safe.
 2. Cardioversion: If the patient is hemodynamically unstable, typically considered safe
during pregnancy.
3. Long-term Management: Beta-blockers or antiarrhythmic drugs as needed and safe.
4. Monitoring: Continuous fetal monitoring during acute episodes and regular maternal
cardiac monitoring.

Complications
1. Sudden Cardiac Death: Due to sustained VT or progression to ventricular fibrillation.
2. Heart Failure: Due to prolonged high heart rates, exacerbated by pregnancy.
3. Fetal Compromise: Due to reduced maternal cardiac output and uteroplacental blood
flow.
4. General Management Considerations:
5. Multidisciplinary Care: Involving cardiologists, obstetricians, and anesthesiologists.
6. Fetal Monitoring: Continuous monitoring during acute episodes of arrhythmia.
7. Delivery Planning: Consideration of timing and mode of delivery based on maternal and
fetal condition.

RISK FACTORS FOR CARDIAC DISEASES IN PREGNANCY

MODIFIABLE RISK FACTORS
1. Smoking
Smoking during pregnancy significantly increases the risk of cardiac diseases. The chemicals in
cigarettes, including nicotine and carbon monoxide, lead to vasoconstriction, increased blood
pressure, and heart rate. This can result in placental insufficiency and reduced oxygen delivery to
the fetus, ultimately affecting both maternal and fetal cardiovascular health. Quitting smoking
can significantly reduce these risks (Cnattingius, 2004).
2. Diet
A diet high in saturated fats, trans fats, and cholesterol can contribute to the development of
atherosclerosis and hypertension. Poor dietary habits can lead to excessive weight gain,
gestational diabetes, and pre-eclampsia, all of which are significant risk factors for cardiac
diseases during pregnancy. Additionally, a diet low in essential nutrients such as folate, iron, and
omega-3 fatty acids can impair cardiovascular health. Maintaining a balanced diet rich in fruits,
vegetables, whole grains, and lean proteins is crucial for cardiovascular health (Melzer, Schutz,
& Stehle, 2009).
3. Physical Inactivity
Lack of regular physical activity is associated with obesity, hypertension, and diabetes, all of
which increase the risk of cardiac diseases. Engaging in regular, moderate exercise can help
maintain a healthy weight, lower blood pressure, and improve overall cardiovascular health.
Activities such as walking, swimming, and prenatal yoga are recommended for pregnant women
to maintain their cardiovascular fitness (American College of Obstetricians and Gynecologists,
2015).
4. Obesity
Obesity is a major modifiable risk factor for cardiovascular diseases. Excessive body weight
can lead to increased blood pressure, dyslipidemia, and insulin resistance, all of which contribute
to heart disease. Managing weight through a healthy diet and regular exercise is essential for
reducing cardiovascular risks during pregnancy (Catalano & Shankar, 2017).
NON-MODIFIABLE RISK FACTORS
1. Age
Advanced maternal age (over 35) is a significant risk factor for cardiac diseases during
pregnancy. Older women are more likely to have pre-existing conditions like hypertension,
diabetes, and other cardiovascular issues that can complicate pregnancy. Additionally, the
physiological changes associated with aging, such as reduced arterial elasticity, can exacerbate
these risks (Goel et al., 2018).
2. Genetics
A family history of cardiovascular disease can increase the likelihood of cardiac problems
during pregnancy. Genetic predispositions can affect lipid metabolism, blood pressure
regulation, and vascular function, making individuals more susceptible to heart disease.
Identifying and managing these risks through regular monitoring and early intervention is
essential (Lloyd-Jones et al., 2010).
3. Ethnicity
Certain ethnic groups have a higher prevalence of cardiovascular risk factors. For example,
African American women are more likely to experience hypertension and pre-eclampsia
compared to their Caucasian counterparts. Understanding and addressing these ethnic disparities
is important for reducing cardiovascular risks during pregnancy (Khan et al., 2018).
4. Pre-existing Medical Conditions
Conditions such as congenital heart defects, chronic hypertension, and diabetes mellitus
increase the risk of cardiovascular complications during pregnancy. These conditions require
careful monitoring and management to minimize adverse outcomes (Regitz-Zagrosek et al.,
2011).
Pregnancy-Specific Factors
a. Gestational Diabetes
Women who develop gestational diabetes are at an increased risk of developing type 2 diabetes
and cardiovascular diseases later in life. Gestational diabetes can cause endothelial dysfunction
and increased arterial stiffness, contributing to long-term cardiovascular risk. Managing
gestational diabetes through diet, exercise, and medication when necessary is crucial for reducing
these risks (Bellamy et al., 2009).
b. Hyperemesis Gravidarum
Severe nausea and vomiting during pregnancy, known as hyperemesis gravidarum, can lead to
electrolyte imbalances and dehydration, potentially affecting cardiovascular function. Proper
hydration and electrolyte management are necessary to mitigate these risks (Einarson et al.,
2013).
c. Placental Abruption
Placental abruption, where the placenta detaches prematurely from the uterus, can cause severe
bleeding and cardiovascular stress. This condition requires immediate medical attention to
prevent serious complications for both the mother and the baby (Tikkanen, 2011).
Other Contributing Factors include;
1. Stress
Pregnancy can be a stressful period, and chronic stress can lead to hypertension and other
cardiovascular issues. Stress activates the body's sympathetic nervous system, leading to
increased heart rate and blood pressure. Chronic stress also promotes inflammation and oxidative
stress, both of which are harmful to cardiovascular health. Effective stress management
techniques, such as mindfulness, yoga, and adequate rest, are essential for maintaining
cardiovascular health during pregnancy (Bergen & Wallis, 2007).
2. Alcohol Consumption
Alcohol intake during pregnancy can lead to various complications, including cardiac diseases.
Alcohol can affect lipid metabolism, increase blood pressure, and contribute to arrhythmias. It is
recommended that pregnant women abstain from alcohol to minimize these risks. Even moderate
alcohol consumption can have adverse effects on both maternal and fetal cardiovascular health
(Patra et al., 2011).
3. Substance Abuse
The use of illicit drugs, such as cocaine and methamphetamine, can have severe cardiovascular
consequences, including arrhythmias, myocardial infarction, and sudden cardiac death. Pregnant
women should avoid all forms of substance abuse to protect their cardiovascular health (Jaffe,
2002).
4. Environmental Exposures
Exposure to environmental toxins, such as lead, air pollution, and secondhand smoke, can
increase the risk of cardiovascular diseases. Pregnant women should minimize exposure to these
harmful substances to reduce cardiovascular risks (Brook et al., 2010).
DIAGNOSTICS OF CARDIAC DISEASES IN PREGNANCY
Medical History and Physical Examination
Medical History
 Pre-existing Conditions: Document any pre-existing heart conditions, such as congenital
heart disease, rheumatic heart disease, or previous episodes of endocarditis.
 Symptoms: Note symptoms like dyspnea, chest pain, palpitations, syncope, or fatigue.
Inquire about the duration, frequency, and triggers of these symptoms.
 Family History: Assess for any family history of cardiac diseases or sudden cardiac
death.
 Obstetric History: Review previous pregnancies, any complications related to cardiac
issues, and outcomes.

Physical Examination:
 Vital Signs: Regularly monitor blood pressure, heart rate, respiratory rate, and oxygen
saturation.
 Cardiac Auscultation: Listen for murmurs, gallops, or any abnormal heart sounds. Pay
attention to changes that may indicate increased cardiac workload.
  Peripheral Edema: Check for signs of fluid retention, such as swelling in the legs and
ankles.
 Jugular Venous Pressure (JVP): Elevated JVP may indicate right heart failure or
increased central venous pressure.
 Pulmonary Examination: Listen for crackles or rales that may suggest pulmonary
congestion.

Diagnostic Tests
 Electrocardiogram (ECG): Detects arrhythmias, ischemic changes, or signs of ventricular
hypertrophy. Normal pregnancy can cause some ECG changes, such as a slight left axis
deviation, which need to be differentiated from pathological changes.
 Echocardiography: Provides detailed information about cardiac structure and function,
valve function, and ventricular performance. It is safe in pregnancy and can be repeated if
necessary. It’s crucial for assessing the severity of any cardiac lesions and monitoring
changes over time.
 Chest X-ray: Evaluates heart size and shape, and detects pulmonary edema or other lung
pathology. There is need to use shielding to minimize fetal exposure to radiation.
Consider alternative imaging if the risk is deemed high.
 Blood Tests

1. B-type Natriuretic Peptide (BNP) or N-terminal pro-BNP (NT-proBNP): This are markers for
heart failure. Elevated levels can indicate increased cardiac stress. Levels may be physiologically
elevated in pregnancy, so results should be interpreted with caution.
2. Complete Blood Count (CBC): This is to assess for anemia, which can exacerbate cardiac
conditions. Leukocytosis or thrombocytopenia can also have implications for cardiac health.
Considerations: Physiological anemia is common in pregnancy, but significant deviations should
be investigated.
3. Serum Electrolytes and Renal Function Tests: Electrolyte imbalances and renal function can
impact cardiac health and are important in the management of cardiac diseases. Hence renal
function need to be monitored closely, especially if using medications that can affect kidney
function.
CONSIDERATIONS FOR DIAGNOSTIC TESTING IN PREGNANT WOMEN
Diagnosing cardiac diseases in pregnant women requires a careful and thorough approach,
balancing the need for accurate diagnosis with the safety of both mother and fetus.
Comprehensive medical history, detailed physical examination, and judicious use of diagnostic
tests are critical components of effective care.
1. Safety: Prioritize the safety of both the mother and the fetus. Avoid tests involving ionizing
radiation unless absolutely necessary and consider alternatives.
2. Timing: Certain diagnostic tests may be deferred until after delivery if the mother’s condition
is stable and the risks of testing outweigh the benefits.
3. Multidisciplinary Approach: Involve a team of specialists, including obstetricians,
cardiologists, and radiologists, to ensure comprehensive care and appropriate interpretation of
diagnostic results.
4. Monitoring: Frequent monitoring may be required to track the progression of cardiac disease
and adjust treatment plans accordingly.
5. Patient Education: Inform the patient about the purpose and potential risks of each diagnostic
test, ensuring informed consent is obtained.
TREATMENT/MANAGEMENT AND PREVENTION OF CARDIAC DISEASES DUE
TO PREGNANCY, INCLUDING LIVING WITH CARDIAC DISEASES IN
PREGNANCY
Treatment/Management and Prevention of Cardiac Diseases Due to Pregnancy
Managing cardiac diseases during pregnancy requires a comprehensive approach that considers
both maternal and fetal well-being. This involves lifestyle modifications, medication
management, surgical interventions when necessary, cardiac rehabilitation, and managing co-
existing conditions.
A. Primary Prevention/Lifestyle Modifications
Lifestyle changes are fundamental in managing cardiac diseases during pregnancy. These
include:
1. Diet: A heart-healthy diet is essential, which includes diet low in saturated fats, trans fats,
cholesterol, and sodium, and high in fruits, vegetables, whole grains, and lean pproteins
Adequate intake of essential nutrients is also important, such as folic acid, iron, and calcium,
which are crucial for both maternal and fetal health (Sliwa et al., 2020).
2. Exercise: Moderate physical activity is encouraged as it helps maintain cardiovascular fitness,
manage weight, and reduce stress. Activities such as walking, swimming, and prenatal yoga are
generally considered safe (Regitz-Zagrosek et al., 2018). The type and intensity of exercise
should also be tailored to the individual’s cardiovascular status and overall health.
3. Smoking Cessation: Quitting smoking is imperative as smoking can worsen cardiac conditions
and increase risks for both the mother and fetus. Smoking cessation programs and support can be
beneficial (Rosenthal et al., 2019).
4. Alcohol Consumption: Alcohol intake should be avoided or minimized as it can exacerbate
cardiac conditions and adversely affect fetal development (Sliwa et al., 2020).
Primary prevention of cardiac diseases in pregnancy also includes the management of Co-
existing conditions (risk factors), such as diabetes, hypertension and Obesity.
a. Diabetes: Gestational diabetes increases the risk of cardiac diseases. Tight glycemic control is
essential to reduce the risk of adverse maternal and fetal outcomes. Insulin therapy is preferred
over oral hypoglycemic agents (Mehta et al., 2019).
b. Hypertension: Blood pressure should be closely monitored and managed with medications that
are safe for use in pregnancy, such as methyldopa or labetalol (European Society of Cardiology,
2018).
c. Obesity: Obesity is a significant risk factor for cardiac diseases. Weight management through
diet and exercise is essential (Bari et al., 2021).
B. Secondary Prevention
Secondary prevention aims at early detection and prompt management of cardiac conditions to
prevent progression and complications. These include:
1. Screening and Monitoring:
a. Prenatal Visits: Regular prenatal visits allow for monitoring blood pressure, weight, and
overall cardiovascular health. Early detection of potential issues can lead to timely interventions
(Regitz-Zagrosek et al., 2018).
b. Blood Tests: Regular blood tests to monitor lipid profiles, glucose levels, and other markers of
cardiovascular health are important (James et al., 2022).
2. Early Detection and Treatment:
a. Cardiac Imaging: Echocardiography and other imaging techniques can help detect structural
heart diseases early in pregnancy (Thorne et al., 2019).
b. Medication Management: Safe medications should be prescribed to manage hypertension,
diabetes, and other conditions in pregnant women. Adjustments to medications should be made
to avoid teratogenic effects (Regitz-Zagrosek et al., 2018).
C. Public Health Measures and Awareness Campaigns
Public health measures and awareness campaigns are vital for disseminating information and
encouraging preventive practices among pregnant women. They include:
1. Education Programs
a. Prenatal Education: Educational programs for expectant mothers should include information
on maintaining cardiovascular health and recognizing early signs of cardiac diseases (James et
al., 2022).
b. Healthcare Provider Training: Training for healthcare providers to recognize and manage
cardiac conditions in pregnancy is essential (Thorne et al., 2019).
2. Community Outreach:
a. Support Groups: Establishing support groups for pregnant women can provide emotional
support and practical advice for maintaining cardiovascular health (Bari et al., 2021).
b. Public Campaigns: Public health campaigns through media and community events can raise
awareness about the importance of cardiovascular health in pregnancy (Harrell et al., 2019).
Other management of cardiac diseases due to pregnancy include:
1. Medical Management
The safety of medications during pregnancy is a critical consideration as some drugs used to treat
cardiac diseases are contraindicated in pregnancy due to potential teratogenic effects. The
following medications are however safe to use:
a. Antihypertensives: Beta-blockers (e.g., labetalol) are commonly used and generally considered
safe in pregnancy, while ACE inhibitors and angiotensin II receptor blockers (ARBs) are
typically avoided due to their association with fetal renal damage and other complications
(European Society of Cardiology, 2018).
b. Anticoagulants: Low molecular weight heparin (LMWH) is preferred over warfarin, especially
in the first trimester, due to the lower risk of teratogenic effects. Regular monitoring of
coagulation status is essential to ensure therapeutic effectiveness and safety (European Society of
Cardiology, 2018).
c. Diuretics: Is used primarily to manage heart failure symptoms, but careful monitoring is
required to avoid electrolyte imbalances and potential impacts on placental perfusion (Regitz-
Zagrosek et al., 2018).
2. Surgical and Interventional Procedures
Surgical interventions during pregnancy are reserved for cases where medical management is
insufficient and the benefits outweigh the risks. These interventions include:
a. Percutaneous Interventions: Procedures like balloon valvuloplasty or percutaneous coronary
interventions can be performed if necessary, typically in the second trimester when the risk to the
fetus is lower (Mehta et al., 2019).
b. Cardiac Surgery: In critical cases, cardiac surgery may be necessary, however, timing and type
of surgery are carefully considered to minimize risks to the mother and fetus. Cardiac surgery
with cardiopulmonary bypass carries significant risks and is generally reserved for life-
threatening conditions (Sliwa et al., 2020).
3. Cardiac Rehabilitation: Cardiac rehabilitation programs tailored for pregnant women with
cardiac diseases include:
a. Physical Activity: includes Supervised exercise programs that accommodate the individual’s
cardiovascular status and pregnancy-related changes (Regitz-Zagrosek et al., 2018).
b. Education and Support: involves providing education about lifestyle modifications, medication
adherence, and recognizing signs of cardiac decompensation (Rosenthal et al., 2019).
c. Psychosocial Support: involves addressing the emotional and psychological impact of
managing cardiac disease during pregnancy, which can include counseling and support groups
(Sliwa et al., 2020).

* Living with Cardiac Diseases in Pregnancy

Pregnancy poses unique challenges for women living with cardiac diseases, necessitating a
comprehensive and multidisciplinary approach to care. The following can be done to ease the
burdens and complexities associated with having to live with Cardiac Diseases in Pregnancy:
1. Psychological and Emotional Impact - Living with a cardiac disease during pregnancy can be
emotionally and psychologically challenging. Anxiety and depression are common, driven by
concerns about the health of both the mother and the fetus. Studies have shown that
psychological support, including counseling and therapy, can significantly improve the quality of
life for these women. Tailored psychological interventions that address both the emotional
burden of a cardiac condition and the specific stressors of pregnancy can help reduce anxiety and
improve outcomes.
2. Support Systems and Resources: Effective management of cardiac diseases in pregnancy
requires a robust support system. This includes a multidisciplinary healthcare team consisting of
cardiologists, obstetricians, midwives, and other specialists. Support groups and educational
programs can provide valuable information and emotional support. These resources help women
connect with others in similar situations, share experiences, and gain practical advice on
managing their conditions .
3. Long-term Monitoring and Follow-up: Long-term monitoring is crucial for pregnant women
with cardiac diseases. Regular follow-ups with the healthcare team help to track the progression
of the disease and make timely adjustments to the treatment plan. Monitoring typically includes
frequent cardiovascular assessments, echocardiograms, and other diagnostic tests as needed.
4. Postpartum Considerations and Care: Postpartum care for women with cardiac diseases
involves both immediate and long-term strategies. In the immediate postpartum period, careful
monitoring for heart failure, arrhythmias, and other cardiac complications is essential. Women
may require adjustments in medication and ongoing support to manage their conditions. Long-
term postpartum care include lifestyle modifications, such as maintaining a heart-healthy diet,
regular exercise, and smoking cessation. Breastfeeding is generally encouraged, but it requires
careful management of medications to ensure they are safe for the infant. Continuous education
on recognizing symptoms and seeking prompt medical attention can help prevent complications .

CONCLUSION
Although cardiac diseases in pregnancy are uncommon, they are very serious medical conditions
and it is important for pregnant women to do constant checkups, and for the healthcare
professionals to identify any potential risks of cardiac diseases and any underlying diseases in
order to improve the health of the pregnant woman. Education is also important as some lifestyle
factors may pose a risk, and constant monitoring is required due to the changes in cardiovascular
system of the pregnant woman.
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