Cardiac disease in pregnancy. Part 2: acquired heart disease

Abstract

Key content The incidence of both rheumatic and ischaemic heart disease is expected to increase in the UK because of changes in ethnicity and increasing maternal age. Effective management of valvular heart lesions is based on the treatment of symptoms, with the option of balloon valvuloplasty and valve replacement. Acute myocardial infarction poses a significant risk of maternal mortality and requires prompt treatment with heparin, beta‐blockers and nitrates. Peripartum cardiomyopathy, although rare, is associated with significant maternal mortality and morbidity. Learning objectives To know about the causes of acquired heart disease in pregnancy. To understand the general management principles for valvular heart lesions, ischaemic heart disease and cardiac arrhythmias when encountered during pregnancy. Ethical issues Warfarin is teratogenic if used in the first trimester. Is it ethical not to use it, knowing that it reduces the risk of valve thrombosis and maternal mortality? Please cite this article as: Gelson E, Johnson M, Gatzoulis M, Uebing A. Cardiac disease in pregnancy. Part 2: acquired heart disease. The Obstetrician & Gynaecologist 2007;9:83–87.