Myocardial ischemia and other cardiovascular diseases during pregnancy

Although ischemic heart disease during pregnancy is quite rare, it is becoming more and more common, caused by women delaying pregnancy as well as increasing obesity rates. In addition, other cardiovascular diseases in pregnant women also put women at risk for a pregnancy that requires specialized care during labor and postpartum.

During pregnancy, every organ system needs changes, including the heart and blood vessels. These changes put extra stress on the mother's body and require the heart to work harder, ensuring that the baby gets enough oxygen and nutrients:
Increased blood volume: During the first trimester, the amount of blood is increased. blood in the body increases from 40 to 50%. Increased cardiac output: Cardiac output is the amount of blood pumped by the heart per minute. During pregnancy, cardiac output also increases by 30 to 40% due to increased blood volume. Increased heart rate: The heart rate usually increases by 10 to 15 beats per minute at rest. Lowers blood pressure: Blood pressure can drop by 10mmHg during pregnancy, due to hormonal changes and because more blood is directed to the uterus. Changes in heart and blood vessel function during pregnancy can make you feel tired, short of breath, and dizzy. Although all of these symptoms are normal, pregnant women should consult a doctor for support when poor tolerance affects quality of life.

Myocardial ischemia during pregnancy is uncommon. However, because of the increasing age of mothers during pregnancy, the risk of coronary heart disease during pregnancy also increases.
Atherosclerosis appears to be the most common cause of acute myocardial infarction, although coronary artery spasm, coronary artery dissection, and thrombosis have been reported among other causes of myocardial ischemia. during pregnancy.
The diagnosis of ischemic heart disease in pregnant women can be difficult and not without risk to the fetus. At the same time, the use of thrombolytic drugs, percutaneous coronary intervention and optimal medical treatment for ischemic heart disease in pregnancy still need many considerations.
However, pregnancy itself appears to be a risk factor for acute myocardial infarction if not optimally controlled prior to pregnancy. The incidence of maternal morbidity after acute myocardial infarction is increased due to increased rates of heart failure, arrhythmia and cardiogenic shock. In addition, indications for labor in women with a history of acute coronary syndrome should also be consulted specifically for each case, not for cardiovascular indications, including termination of pregnancy.

Presence of abnormal shunt Presence of abnormal shunt in the heart is the simplest and most common congenital heart defect. The septal holes include atrial septal defect, ventricular septal defect, and ductus arteriosus.
If the hole is large, a relative amount of blood from the left side of the heart will flow back into the right side of the heart. This vicious cycle will result in an enlarged heart, irregular heartbeat and increased pressure in the lungs, causing low oxygen levels in the blood, and the skin and mucous membranes become blue.
In such cases, pregnancy is not recommended due to the high risk of maternal mortality.
Obstructive lesions Obstructive lesions reduce blood flow to the heart and major blood vessels of the body. One of these lesions, coarctation of the aorta or aortic spasm, can predispose a woman to high blood pressure.
This condition can also cause the placenta to not receive enough blood. Depending on the severity of the stenosis, you may need intervention before or during pregnancy to keep yourself and your baby safe during pregnancy.
Complicated injury Transposition of the great arteries, which means that the aorta and pulmonary artery are attached to the wrong ventricle, requires surgical repair to be performed early to ensure cardiac function. However, complications of heart failure and open heart valves are quite common, so women need to be closely monitored during pregnancy.
Cyanotic heart disease with tetralogy of Fallot, when surgically repaired, can cause pulmonary valve regurgitation, leading to heart failure and arrhythmias. Therefore, women need to correct these problems before becoming pregnant.
In general, most women with congenital heart defects who have had corrective surgery can get pregnant safely. However, the outcome of pregnancy and the risk of complications depends on the type of heart defect you have, the severity of your symptoms, and whether you have heart muscle dysfunction, arrhythmias, or hypertension. pulmonary artery disease with associated pulmonary disease or not.
Heart valve disease Narrowing of the heart valves that impede the flow of blood. If the stenosis is severe, the heart has to work harder to pump blood, which increases during pregnancy, through the narrowed valve. Therefore, this can lead to heart failure. Therefore, valve repair or valve replacement surgery should be indicated if the patient with heart valve disease wishes to become pregnant.
Besides, after prosthetic heart valve surgery, the patient needs to take anticoagulants for life and possibly some drugs that affect the fetus. As such, it is very important that these subjects be evaluated by a cardiologist before planning a pregnancy. Your doctor will advise you on the potential risks of becoming pregnant as well as determine the best course of anticoagulant therapy for your pregnancy and especially during labor.
Aortic disease Women with conditions that affect the aorta, such as aortic aneurysms, dilated aorta or connective tissue disorders such as Marfan syndrome, are at higher risk when pregnant. Because pressure in the aorta increases during pregnancy, labor increases the pressure, which can lead to rupture or dissection of the aorta, which can be life-threatening.
Therefore, women with aortic disease must be evaluated by a cardiologist before planning a pregnancy. It is also important to note that some conditions, such as Marfan syndrome, are hereditary and genetic counseling should be performed antenatally.

If you have been diagnosed with heart disease during pregnancy, before you begin planning for a baby, you should be evaluated by a cardiologist and obstetrician who specializes in high-risk pregnancies. Some heart conditions during pregnancy such as:
High blood pressure . Blood cholesterol disorders. Cardiac ischemic disease. Vascular diseases, including aortic disease. Heart rhythm disturbances. Cardiac disease. Heart failure. Marfan syndrome. Rheumatic fever. Previous cardiovascular events such as myocardial infarction, transient ischemic attack, or stroke. Severe stenosis of the mitral or aortic valve or the outflow tract of the aorta. Ejection fraction less than 40. At this point, the cardiologist will do a physical exam and order diagnostic tests to check and assess the extent of cardiovascular disease in pregnant women. After reviewing the test results, the cardiologist will talk with the woman planning a pregnancy and her family about how safe it is to get pregnant and the risk of complications.
In case you want to get pregnant, your cardiologist can tell you about any medications or other treatments that need to be prescribed before getting pregnant. At the same time, all medications you are taking may need to be reviewed, changing the dosage if necessary to make it safer during pregnancy.
Thus, by preparing for pregnancy and following up regularly with a cardiologist throughout pregnancy, most women with heart disease can have a safe pregnancy and a healthy baby.
In conclusion, heart disease during pregnancy is an important risk factor for pregnancy. If you already have heart disease, the best way to ensure a healthy pregnancy is to see a cardiologist before you start planning a pregnancy. By examining, performing tests as well as appointing optimal treatment, including surgical intervention, cardiovascular disease in pregnant women can no longer be a barrier to realizing this sacred mission. .