Pregnancy in the Woman with Heart Disease

The Big Heart Disease Lie

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Before becoming pregnant, a woman may have a congenital heart defect or acquired heart disease. Many congenital defects can now be surgically repaired in infancy, and the first generation of these patients has only recently reached childbear-ing age. They represent a new kind of patient for obstetricians and cardiologists.

Acquired heart disease in pregnant women includes primarily rheumatic disease involving heart valves, heart failure, and coronary artery disease. Because many women are now delaying pregnancy until they are older, acquired heart disease is somewhat more common in pregnant women than earlier in this century.

When considering pregnancy in the presence of heart disease, the most important factor is the severity of the heart-related symptoms. In general, patients without symptoms or those only slightly symptomatic enjoy a good outlook for both mother and fetus.

In the moderately or severely symptomatic patient, both maternal and fetal health are at high risk. Thorough evaluation by history, physical examinations, and diagnostic testing will allow the physician to assess the risk of pregnancy to mother and fetus. For the patient who requires drug therapy, consideration of risk to the fetus is especially important. Fortunately, many cardiac drugs can be safely administered during pregnancy.

In some cases, intervention such as coronary artery angio-plasty (balloon dilatation of a coronary artery) or surgical repair of a valve may be necessary for maternal survival and cannot be delayed until after delivery. Although risk to the fetus is increased, many of these procedures have been successfully performed with a good outcome for both mother and fetus.

Heart disease in adults generally develops later in life. Although heart disease is not completely preventable, there are many things that can be done to help enjoy a healthy, longer life free from heart disease.

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