Heart disease: Problem diseases in pregnancy

Heart disease: Problem diseases in pregnancy

Most heart disease in women of childbearing age is rheumatic in origin despite the recent great reduction in the prevalence of rheumatic fever. Better living conditions in the UK and the more prompt treatment of streptococcal sore throats with antibiotics in childhood have reduced rheumatic damage to the heart valves and myocardium. An increasing proportion of pregnant women have congenital heart lesions that have been treated previously.
Pregnancy puts an increased load on the cardiovascular system. More blood has to be circulated so that cardiac output increases by up to 40% by mid-pregnancy, staying steady until labour, when it increases further. This increased cardiac work cannot be done as effectively by a damaged heart; if the heart is compromised a woman would be wise to avoid other increased loads that might precipitate cardiac failure. The most frequently encountered are:

• Household work
• Recrudescence of rheumatic fever
• Paid work outside the home
• Care of other family members
• Respiratory infection
• Pre-eclampsia
• Urinary infection
• AnaemiaBacterial endocarditis

Care should be taken just after delivery: with the uterine retraction up to a litre of blood can be swiftly shunted from the uterine veins into the general venous system.


References:
Geoffrey Chamberlain. 2002. ABC of Antenatal Care. London: BMJ Books.
Image Source: http://www.nhs.uk/Conditions/Congenital-heart-disease/Pages/Complications.aspx

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