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ESC Congress: Task Force on the Management of Cardiovascular Diseases during Pregnancy
September 03, 2003IMPORTANT: This press release accompanies a presentation given at the ESC Congress 2003.
Written by the investigator himself/herself, this press release does not necessarily reflect the opinion of the European Society of Cardiology
Most pregnant women have normal hearts and most patients with heart disease are not contemplating pregnancy so many cardiologists and obstetricians are nervous about advising young women with heart disease because of their lack of experience.
Cardiologists more than any other specialists rely on evidence from clinical trials but there is no evidence basis to guide the clinician on the management and outcome of pregnancy in different cardiac conditions. Most drugs in use have become approved through lack of reported ill-effects (the exception is warfarin but there is no effective alternative).
Guidance comes from observational experience and a detailed knowledge of the cardiac condition in each patient which allows prediction of how the heavy demands on the cardiovascular system during pregnancy are likely to be handled.
Congenital heart disease has eclipsed rheumatic valve disease in prevalence thanks to successful surgery of previously fatal defects in infancy and the demise of rheumatic fever in the western world. More coronary artery disease is being seen as women defer their pregnancies.
Most women with congenital septal defects and leaking valves do well but narrowed valves, prosthetic valves, outgrown surgical conduits, cyanosis and fragile aortas are a worry and pulmonary hypertension is dangerous both by limiting blood flow and because it tends to get worse.
Cardiovascular complications of pregnancy which may afflict women without pre-existing heart disease include pre-eclampsia, arrhythmias, peripartum cardiomyopathy and pulmonary embolism. Women with pre-existing heart disease are not immune from these disorders which bring particular risk because of their reduced reserves.
High blood pressure is the commonest cardiovascular complication of pregnancy and remains one of the leading causes of both maternal and perinatal morbidity and mortality. Pre-eclampsia is a reversible systemic disease of pregnancy which may be superimposed on previous hypertension or appear de novo in later pregnancy. It is believed to be caused by release of a circulating factor from the placenta which causes generalised vasoconstriction, reduced organ perfusion and coagulation abnormalities but is still incompletely understood and usually reversed only by delivery of the baby.
Percutaneous intervention can be performed during pregnancy when essential. Balloon opening of narrowed valves, device closure of abnormal communications, radio frequency ablation of abnormal arrhythmic pathways and DC cardioversion can all be performed without disturbing the fetus. Ultrasound can be used to minimise irradiation.
The focus is on team work between all concerned: local general practitioners, physicians and obstetricians and regional teams of cardiologists, obstetricians, anaesthetists and geneticists as appropriate. Shared care is feasible for all but the highest risk patients and minimises travelling.
Celia Oakley MD FESC
European Society of Cardiology (ESC)
Heart Disease Current Events and Heart Disease News RSSApple or pear shape is not main culprit to heart woes — it's liver fat
For years, pear-shaped people who carry weight in the thighs and backside have been told they are at lower risk for high blood pressure and heart disease than apple-shaped people who carry fat in the abdomen. But new findings from nutrition researchers at Washington University School of Medicine in St. Louis suggest body-shape comparisons don't completely explain risk.
Cardiovascular disease causing increasing inequity between rich and poor
A new paper released today by The George Institute for International Health is warning a cardiovascular disease based epidemic is gaining pace among many low- and middle-income countries (LMIC), exemplified at its worst in the world's largest populated countries - China and India.
Fruit fly research may lead to better understanding of human heart disease
Researchers at the Burnham Institute for Medical Research (Burnham) have shown in both fruit flies and humans that genes involved in embryonic heart development are also integral to adult heart function. The study, led by Rolf Bodmer, Ph.D., was published in Proceedings of National Academy of Sciences.
Presence of gum disease may help dentists and physicians identify risk for cardiovascular disease
Individuals reporting a history of periodontal disease were more likely to have increased levels of inflammation, a risk factor for heart disease, compared to those who reported no history of periodontal disease.
Estrogen therapy could be dangerous for women with existing heart risk
Hormone therapy could accentuate certain pre-existing heart disease risk factors and a heart health evaluation should become the norm when considering estrogen replacement, new research suggests.
Researchers identify how binge drinking may drive heart disease
As the holidays arrive, a group of researchers has identified the precise mechanisms by which binge drinking contributes to clogs in arteries that lead to heart attack and stroke, according to a study published today in the journal Atherosclerosis.
Why women should eat less, move more and consider wearing transdermal HRT patches during menopause
Weight and appetite experts from around the world met at a conference in Bangkok earlier this year to discuss sex differences in obesity. One line of discussion looked at factors leading to women's weight gain during menopause, and how it might be avoided.
Mechanisms of cardiovascular disease and cancer give clues to new therapies
Cardiovascular conditions leading to heart attacks and strokes are treated quite separately from common cancers of the prostate, breast or lung, but now turn out to involve some of the same critical mechanisms at the molecular level.
Scientists discover 21st century plague
Bacteria that can cause serious heart disease in humans are being spread by rat fleas, sparking concern that the infections could become a bigger problem in humans.
MU study reveals effective anti-tobacco ads should either scare or disgust viewers
Now's the perfect time to increase anti-smoking campaigns - Nov. 20 is the American Cancer Society's Great American Smokeout.
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