{"id":1231,"date":"2017-01-25T15:12:37","date_gmt":"2017-01-25T15:12:37","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=1231"},"modified":"2017-08-21T10:26:46","modified_gmt":"2017-08-21T10:26:46","slug":"primary-care-corner-with-geoffrey-modest-md-pregnancy-and-congenital-heart-disease-management","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2017\/01\/25\/primary-care-corner-with-geoffrey-modest-md-pregnancy-and-congenital-heart-disease-management\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: pregnancy and congenital heart disease management"},"content":{"rendered":"<p><strong>By Dr. Geoffrey Modest <\/strong><\/p>\n<p>There was a new guideline from the American Heart Association\u00a0on the management of congenital heart disease in pregnancy (see\u00a0<a href=\"http:\/\/circ.ahajournals.org\/content\/early\/2017\/01\/12\/CIR.0000000000000458?sid=3d46cd93-3125-4db0-8f6c-a1002093e09d\">http:\/\/circ.ahajournals.org\/content\/early\/2017\/01\/12\/CIR.0000000000000458?sid=3d46cd93-3125-4db0-8f6c-a1002093e09d<\/a>\u00a0\u00a0). Given that this is not a common primary care issue, I will broadly\u00a0review their approach\u00a0and defer to the article itself for the specifics<\/p>\n<p>In (very) brief, this article has sections on:<\/p>\n<ul>\n<li>Physiology of pregnancy and its effects on the heart\/lungs (e.g. increased blood volume, increased cardiac output, decreased oncotic pressure, increased heart rate,\u00a0increased B-type natriuretic peptide,\u00a0vascular tree remodeling to accommodate the increased blood volume, increased pulmonary tidal volume\/minute ventilation)<\/li>\n<li>Preconception counseling\/diagnostic evaluation<\/li>\n<li>Estimating maternal and fetal risk,\u00a0including some risk stratification calculators<\/li>\n<li>Medications in pregnancy (with detailed chart on cardiac meds, pregnancy risk\u00a0category, teratogenic risk, lactation suggestions,\u00a0etc.<\/li>\n<li>Fetal screening<\/li>\n<li>Approach to obstetric care<\/li>\n<li>Therapy for cardiac problems (arrhythmias, heart block, mechanical valves\/anticoagulation, heart failure, cyanosis)<\/li>\n<li>Interventional therapies (transcatheter interventions, cardiovascular surgery, cardioversion, ablation, implantable defibrillators\/pacemakers)<\/li>\n<li>Specific cardiac conditions (pulmonary hypertension, aortic stenosis\/LV outlet tract obstruction, transposition of great arteries, etc.)<\/li>\n<\/ul>\n<p>It seems to be a good reference to keep on hand for those of us\u00a0doing prenatal care, or general medical care of women with congenital heart disease who are thinking of becoming pregnant<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Primary Care Corner with Geoffrey Modest MD: pregnancy and congenital heart disease management [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2017\/01\/25\/primary-care-corner-with-geoffrey-modest-md-pregnancy-and-congenital-heart-disease-management\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-1231","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/1231","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=1231"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/1231\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=1231"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=1231"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=1231"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}