Heart disease in pregnancy

Abstract

Heart disease is the most common cause of maternal death in industrialized nations, sudden arrhythmic death, myocardial dysfunction, coronary disease and aortic dissection being the most frequent underlying causes. Other particularly high-risk conditions include severe valvar stenosis, mechanical heart valves and pulmonary arterial hypertension. Pregnancy and childbirth exert physiological stress on the circulation, so women whose heart condition limits their ability to increase cardiac output are at high risk. Women of childbearing potential who have heart disease should be made aware that pregnancy can carry a high risk, and should be offered safe and effective contraception, as well as specialist prepregnancy counselling and pregnancy care. Most maternal cardiac deaths occur in women who were not known to have heart disease before their pregnancy; therefore obstetric and acute medicine teams should recognize and act on symptoms of cardiac decompensation early, in order to save the life of the mother and fetus.