By Dr. Geoffrey Modest
There was a new guideline from the American Heart Association on the management of congenital heart disease in pregnancy (see http://circ.ahajournals.org/content/early/2017/01/12/CIR.0000000000000458?sid=3d46cd93-3125-4db0-8f6c-a1002093e09d ). Given that this is not a common primary care issue, I will broadly review their approach and defer to the article itself for the specifics
In (very) brief, this article has sections on:
- Physiology of pregnancy and its effects on the heart/lungs (e.g. increased blood volume, increased cardiac output, decreased oncotic pressure, increased heart rate, increased B-type natriuretic peptide, vascular tree remodeling to accommodate the increased blood volume, increased pulmonary tidal volume/minute ventilation)
- Preconception counseling/diagnostic evaluation
- Estimating maternal and fetal risk, including some risk stratification calculators
- Medications in pregnancy (with detailed chart on cardiac meds, pregnancy risk category, teratogenic risk, lactation suggestions, etc.
- Fetal screening
- Approach to obstetric care
- Therapy for cardiac problems (arrhythmias, heart block, mechanical valves/anticoagulation, heart failure, cyanosis)
- Interventional therapies (transcatheter interventions, cardiovascular surgery, cardioversion, ablation, implantable defibrillators/pacemakers)
- Specific cardiac conditions (pulmonary hypertension, aortic stenosis/LV outlet tract obstruction, transposition of great arteries, etc.)
It seems to be a good reference to keep on hand for those of us doing prenatal care, or general medical care of women with congenital heart disease who are thinking of becoming pregnant
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