High-Risk Cardiac Disease in Pregnancy

Elkayam, Uri; Goland, Sorel; Pieper, Petronella G.; Silversides, Candice K.

doi:10.1016/j.jacc.2016.05.048

Cited by 284 publications

(179 citation statements)

References 92 publications

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“…86,96 Management of SCAD in the pregnant or peripartum patient requires a multidisciplinary team approach 195,196 from cardiology and obstetric services that incorporates management for the mother in combination with considerations for fetal well-being. Recommendations for pregnancy follow-up and delivery after SCAD have been reviewed elsewhere and depend on both maternal and fetal status with the goals of limiting maternal hemodynamic demand and close fetal monitoring.…”

Section: Pregnancy-associated Scad: Diagnosis and Short-term Managementmentioning

confidence: 99%

“…Labetalol is the preferred agent, especially in early pregnancy, because both metoprolol and atenolol are more highly associated with lower placental and fetal weights at delivery. 195,207 Atenolol has also been associated with bradycardia in breastfed infants; therefore, it should also be avoided during breastfeeding. 206,208 …”

Section: Pregnancy-associated Scad: Diagnosis and Short-term Managementmentioning

confidence: 99%

“…197,243,244 Minimizing maternal effort during vaginal delivery, with passive descent in the second stage of labor and delayed Valsalva effort, is advised; operative vaginal delivery or cesarean delivery is used secondarily. 195,197 Because SCAD occurs primarily in women and is associated with pregnancy, there is a presumed pathophysiological association with female sex hormones, although the precise relationship remains unclear. Although there is no direct evidence linking hormonal contraception with recurrent SCAD, exogenous exposure to systemically absorbed hormones, including estrogen and progesterone for contraceptive and post-menopausal therapy, is usually avoided if possible, and they are used only if the nonhormonal options have been considered and the benefits of HT outweigh potential risks.…”

Section: Pregnancy Contraception and Hormone Use After Scadmentioning

confidence: 99%

See 2 more Smart Citations

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

Hayes¹,

Kim²,

Saw³

et al. 2018

Circulation

937

1,344

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Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with female sex, pregnancy, and physical and emotional stress triggers; and concurrent systemic arteriopathies, particularly fibromuscular dysplasia, highlight the differences in clinical characteristics of SCAD compared with atherosclerotic disease. Recent insights into the causes of, clinical course of, treatment options for, outcomes of, and associated conditions of SCAD and the many persistent knowledge gaps are presented.

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Section: Pregnancy-associated Scad: Diagnosis and Short-term Managementmentioning

confidence: 99%

Section: Pregnancy-associated Scad: Diagnosis and Short-term Managementmentioning

confidence: 99%

Section: Pregnancy Contraception and Hormone Use After Scadmentioning

confidence: 99%

See 1 more Smart Citation

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

Hayes¹,

Kim²,

Saw³

et al. 2018

Circulation

937

1,344

View full text Add to dashboard Cite

show abstract

“…Management Hemodynamic problems can lead to either volume or pressure overload of a ventricle. This category includes cardiomyopathies (a weakening of the heart muscle), valvular disease, residual shunts (such as an unrepaired atrial septal defect, ASD), coarctation of the aorta, and pulmonary hypertension (PH) Bitar 2005a, 2005b;Elkayam et al 2016;Pijuan-Domenech et al 2015;Sliwa et al 2016;Wanga et al 2016).…”

Section: Hemodynamic Problems: Cardiomyopathies Congenital Heart Defmentioning

confidence: 99%

At the Heart of the Pregnancy: What Prenatal and Cardiovascular Genetic Counselors Need to Know about Maternal Heart Disease

Morales

Allain

Arscott

et al. 2017

Journal of Genetic Counseling

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In the last decade, an increasing number of cardiac conditions have been shown to have a genetic basis. Cardiovascular genetic counseling has emerged as a subspecialty aiming to identify unaffected at-risk individuals. An important sector of this at-risk population also includes expectant mothers, in whom unique clinical challenges may arise. Genetic counselors, especially those in cardiovascular and prenatal settings, have an opportunity to identify and assist women who may benefit from cardiovascular care during pregnancy. This paper provides basic management and genetic evaluation principles for affected women, as well as guidance on identifying those who are at risk. We provide considerations for cardiac surveillance in pregnancy and the post-partum period. Finally, key psychosocial issues that appraise how to best provide support to at risk women as they make informed decisions are discussed. We propose that a team approach including cardiology, maternal fetal medicine, and genetic counseling best serves this patient population. Ongoing questions addressing an evidence based approach to cardiovascular genetic conditions in pregnancy still remain. Thus, well-designed research protocols are essential to mark progress in this area.

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“…The differential diagnosis includes pre-existing cardiomyopathy, such as familial dilated cardiomyopathy, previous myocarditis, and drug or toxin induced cardiomyopathy; valvular disease, with mitral stenosis and aortic stenosis being the most common valvular abnormalities to be unmasked by pregnancy; congenital heart disease, such as shunt lesions; and pulmonary arterial hypertension. Because circulating plasma volume and cardiac output increase by 50% by the late second trimester and then plateau for the remainder of pregnancy,83 women with these conditions tend to present with dyspnea and heart failure earlier in pregnancy than do women with PPCM; however, it should be noted that heart failure caused by pre-existing cardiomyopathy or valvular disease can also sometimes present late in pregnany 13. The risk of myocardial infarction, from atherosclerotic plaque rupture or spontaneous coronary artery dissection, is three to four times higher in the peripartum period and, more commonly, the early postpartum period compared with non-pregnant women,84 and it may present with chest pain, dyspnea, heart failure, or a combination thereof 8586.…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

Peripartum cardiomyopathy

Honigberg

Givertz

2019

BMJ

145

154

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Peripartum cardiomyopathy (PPCM) is a rare, often dilated, cardiomyopathy with systolic dysfunction that presents in late pregnancy or, more commonly, the early postpartum period. Although the condition is prevalent worldwide, women with black ancestry seem to be at greatest risk, and the condition has a particularly high incidence in Nigeria and Haiti. Other risk factors include pre-eclampsia, advanced maternal age, and multiple gestation pregnancy. Although the complete pathophysiology of peripartum cardiomyopathy remains unclear, research over the past decade suggests the importance of vasculo-hormonal pathways in women with underlying susceptibility. At least some women with the condition harbor an underlying sarcomere gene mutation. More than half of affected women recover systolic function, although some are left with a chronic cardiomyopathy, and a minority requires mechanical support or cardiac transplantation (or both). Other potential complications include thromboembolism and arrhythmia. Currently, management entails standard treatments for heart failure with reduced ejection fraction, with attention to minimizing potential adverse effects on the fetus in women who are still pregnant. Bromocriptine is one potential disease specific treatment under investigation. In this review, we summarize the current literature on peripartum cardiomyopathy, as well as gaps in the understanding of this condition and future research directions.

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High-Risk Cardiac Disease in Pregnancy

Cited by 284 publications

References 92 publications

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

At the Heart of the Pregnancy: What Prenatal and Cardiovascular Genetic Counselors Need to Know about Maternal Heart Disease

Peripartum cardiomyopathy

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