Cardiac Diseases

Cardiac Diseases

During pregnancy, certain changes occur in the cardiovascular system in order to meet the increase demands of the fetoplacental unit thus increasing the workload of the heart. This begins in early pregnancy until the 30^th – 32 ^ndweek when they are maintained until term. These changes include:

Increased cardiac output ,Increased blood volume ,Decreased peripheral resistance

Classification: 

There are four grades

i.                  No symptoms during ordinary physical activity.

ii.                  Symptoms during ordinary physical activity

iii.                  Symptoms during mild physical activity

iv.                  Symptoms at rest.

It describes the extent of the immediate problem but has little predictive value.

Signs And Symptoms: Breathlessness, oedema, irregular pulse,unexplained tachycardia, palpitation, cough, anaemia, loss of energy.

Aetiology: 

The lesions encountered in a patient with heartdisease include mitral stenosis, mitral valve and aortic valve incompetence, congenital heart disease, and cardiomyopathies.

Risk to Fetus:

Growth retardation, fetal loss, increased incidence of congenital heart disease.

Risk to Mother:

Predisposes to bacterial endocarditis, thrombo embolism unless given anticoagulants, increase incidence of death especially with acquired heart disease.

Management

Pre-Conception

·              Patient should see cardiologist before getting pregnant.

·              The patient should be helped to control obesity, cut down smoking and choose diet that will prevent anaemia.

·              Family size should be limited as risk increases with each pregnancy.

Ante Natal Care

a. Diagnosis: early diagnosis to aid prompt management.

b. Assessment of the problem and its prognosis is done,depending on results.

If there is no evidence, follow up is not necessary.

With mild lesion, the patient may not be affected but prophylactic antibiotics cover in labour is necessary.

With significant lesion, the future of the pregnancy needs to be discussed with counseling. If the woman can cope, caesarian section may be done at 37 weeks.

c. Physical care: Depending on severity, antenatal visits shouldbe made more frequent than usual.

In late pregnancy, activities should be restricted or she should be admitted.

Admission is necessary in grades 3 and 4,

Complete bed rest is of utmost importance.

All sources of sepsis should be eliminated to reduce risk of endocarditis.

Intake and output fluids should be maintained

Early ultra-sound scanning (USS) examination of fetus to confirm gestational age and congenital abnormalities; to assess fetal growth, monitor fetal heart rate.

d. Social care: This involves arrangement for transportation and home help services.

e. Psychological Care: Psychological support should be givenespecially with admission to hospital and separation from family.