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Friday, November 1, 2013

Pregnancy and Valvular Heart Disease

 Posted by Chantel Martiromo,  Article By Kyle J. Norton 

Valvular heart disease is defined as a condition of heart disease in which involves in one or more of the problems of valves of the heart. Heart valve problems may be congenital or acquired later in the patient life.

Women who have the valvular heart diseases and would like to get pregnancy
Women who have the valvular heart diseases and would like to get pregnancy are advised to talk to their doctor for the potential risks during pregnancy to the mother and the developing fetus. In a study of "Management of Valvular Heart Disease in Pregnancy" by Patrick T. O'Gara, M.D., F.A.C.C.; Albert E. Raizner, M.D., F.A.C.C. posted in Medsnew today, researcher wrote that the management of women with valvular heart disease should ideally begin before conception. A careful cardiac examination and assessment of functional capacity are needed to determine the likelihood that patients will tolerate the increased hemodynamic burden of pregnancy, labor, and delivery, and the risk of complications during gestation.
A. Your heart and pregnancy

During pregnancy, the blood volume increases by 30 to 50 percent as it is necessary to nourish your growing baby as the result it increases the pressure in the heart as it also require to pump 30%-50% each minutes. Women who have Valvular Heart Disease and want to get pregnant may be associated with risk of Hemodynamic burden that can lead to disability and death.
B. Hemodynamic burden
Therefore, women who have Valvular Heart Disease and would like to get pregnant should have a careful cardiac assessment to determine the risks of increased hemodynamic burden of pregnancy, labor, delivery, and complications in a 40 weeks gestation. As the diseases are associated with the non-pregnancy causes of disability and death of pregnant women in approximately less than 4% of all pregnancies.

C. Diagnosis
After careful recording the personal medical history and physical exam, tests include
1. 12-lead electrocardiogram
12-lead ECG is a types of electrocardiogram in which 12 different electrical signals are recorded at the same time and suggested to use for women with Valvular Heart Disease during pregnancy diagnosis.

2. Trans-thoracic echocardiogram
Trans-thoracic echocardiogram also known as cardiac ultrasound, with the use of echocardiography transducer (or probe) which is placed on the chest wall to produce images of the heart to assess the health of the heart of women with Valvular Heart Disease during pregnancy.

3. Doppler study
Doppler study is another type of an ultrasound used to sound waves produce images for you doctor to check for the blood flow of the arteries and veins.

4. Exercise test
In a study of Exercise in Cardiovascular Disease - "Exercise Testing in Nonatherosclerotic Heart Disease, Hypertrophic Cardiomyopathy, Valvular Heart Disease, and Arrhythmias by Anthony P. Morise, MD, the author stated that the application of exercise testing is often combined with cardiac imaging. This is reflected in recently available appropriate use criteria for myocardial perfusion imaging and stress echocardiography..... In the latest version of the ACC/AHA guidelines for exercise testing published in 2002, 4 HCM is listed as a relative contraindication. However, in the ACC/European Society of Cardiology (ESC) expert consensus document on hypertrophic cardiomyopathy published in 2003, an abnormal exercise systolic blood pressure response is listed as a risk factor for sudden cardiac death in HCM.
Prenatal care of Women who have the disease during pregnancy also are looked after by the joint team of cardiologist and obstetrician. It is suggested of those with mild disease, prenatal visits should be scheduled every month, while in the moderate or severe cases, prenatal visits should be scheduled every 2 weeks until 28 to 30 weeks and weekly thereafter until delivery.

D. Treatments
D.1. Guidelines for Management of Patients With Valvular Heart Disease
According to the ACC/AHA Practice Guidelines for Management of Patients With Valvular Heart Disease" These guidelines follow the format established in previous American College of Cardiology/American Heart Association (ACC/AHA) guidelines for classifying indications for diagnostic and therapeutic procedures:
Class I:
Conditions for which there is evidence and/or general agreement that a given procedure or treatment is useful and effective
Class II:
Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment
IIa. Weight of evidence/opinion is in favor of usefulness/efficacy
IIb. Usefulness/efficacy is less well established by evidence/opinion.
Class III:
Conditions for which there is evidence and/or general agreement that the procedure/treatment is not useful and in some cases may be harmful.
If you would like to read the entire guideline click the Source.

D, 2. Medication
1. Warfarin
Since women with the disease are associated with higher risks of thromboembolism as result of hypercoagulability. Warfarin is one of most recommended medication.
2. Depending to the diagnosis, other treatments may be included
a. Asymptomatic patients
If you are disganosis with Valvular Heart Disease but experience no symptoms, there will no treatment.
b. Pulmonary edema
If you are experience pulmonary congestion or edama, as result of the failure of the heart to remove fluid from the lung circulation, Diuretics medication may be taken orally, depending to the diagnosis.
c. Surgery
If a woman is diagnosis with severity of stenosis with is an abnormal narrowing in a blood vessel of the heart, sugery may be requried.
d. Other treatments depending to diagnosis accordingly
d.1. Infective endocarditis is an inflammation of the inner tissue of the heart may be treated with high dose of antibiotics.
d.2. Coagulation can be treated with anticoagulant to prevents and stops blood from clotting such as warfarin
d.3. Etc.
Women who have the valvular heart diseases during pregnancy
A. Causes

Valvular Heart Disease during pregnancy, in most case, is caused by rheumatic heart disease as a result of rheumatic fever caused by inflammatory disease after Streptococcus pyogenes infection, that can lead to Believed to be caused by antibody cross-reactivity problem of the heart, joints, skin, and brain.

B. Symptoms
Valvular heart diseases during pregnancy symptoms include
1. Palpitations
2.Chest pain
3. Hemoptysis
4. Thromboembolism
5. Opening snap
6. Right-sided heart failure
7. Pulmonary hypertension
8. Heart sounds
9. Etc.

C. Diagnosis
1. Chest X-ray
Chest X ray is used to produced image od the organs inside the chest, including the lung, heart, etc. In patient with Valvular heart disease, X chest X ray may show left atrial enlargement.

2. Echocardiography (ECG)
After chest X ray and abnomality is found in your heart, your doctor may order the Echocardiography to confirm the severity of the abnomality. Echocardiography is a sonogram of the heart.

3. Other test may be similar the diagnosis of prepregnancy of Valvular Heart Disease, depending to the first 2 diagnosis.

D. Treatments
1. Asymptomatic patients
If you are disganosis with Valvular Heart Disease but experience no symptoms, there will no treatment.

2. Pulmonary edema
If you are experience pulmonary congestion or edama, as result of the failure of the heart to remove fluid from the lung circulation, Diuretics medication may be taken, depending to the diagnosis.

3. Surgery
If a woman is diagnosis with severity of stenosis with is an abnormal narrowing in a blood vessel of the heart, sugery may be requried.

4. Other treatments depending to diagnosis accordingly
a. Infective endocarditis is an inflammation of the inner tissue of the heart may be treated with high dose of antibiotics.
b. Coagulation can be treated with anticoagulant to prevents and stops blood from clotting such as warfarin.

c. Etc.

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