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Cardiac disease in pregnancy. Part 2: acquired heart disease

^1. Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK Email: e.gelson{at}imperial.ac.uk (corresponding author)
^2. Chelsea and Westminster Hospital, London, UK
^3. Adult Congenital Heart Disease Unit, Royal Brompton and Harefield NHS Trust and; National Heart and Lung Institute, Imperial College, London SW3 6NP, UK
^4. Adult Congenital Heart Disease Unit, Royal Brompton and Harefield NHS Trust and; National Heart and Lung Institute, Imperial College, London, UK

Key content:

• The incidence of both rheumatic and ischaemic heart disease is expected to increase in the UK because of changes in ethnicity and increasing maternal age.
  
• Effective management of valvular heart lesions is based on the treatment of symptoms, with the option of balloon valvuloplasty and valve replacement.
  
• Acute myocardial infarction poses a significant risk of maternal mortality and requires prompt treatment with heparin, beta-blockers and nitrates.
  
• Peripartum cardiomyopathy, although rare, is associated with significant maternal mortality and morbidity.
  

Learning objectives:

• To know about the causes of acquired heart disease in pregnancy.
  
• To understand the general management principles for valvular heart lesions, ischaemic heart disease and cardiac arrhythmias when encountered during pregnancy.
  

Ethical issues:

• Warfarin is teratogenic if used in the first trimester. Is it ethical not to use it, knowing that it reduces the risk of valve thrombosis and maternal mortality?
  

Please cite this article as: Gelson E, Johnson M, Gatzoulis M, Uebing A. Cardiac disease in pregnancy. Part 2: acquired heart disease. The Obstetrician & Gynaecologist 2007;9:83–87.

Keywords cardiac arrhythmias / cardiomyopathy / ischaemic heart disease / pregnancy / valvular heart disease