Acquired Heart Disease

Acquired Heart Disease

1. Pericarditis

   • inflammation of pericardium
     • infection, cardiac injury, autoimmune response
       • pericardial infusion preventing heart from expanding sufficiently
         • or scarring of pericardium preventing strech
           • difficulty breathing and chest pain

2. Myocardial Infartion

3. Ischaemic Heart Disease

   • uncommon but increasing cause of maternal death
     • risk factors include increasing maternal age, obesity, hypertension, smoking, family history and inequalities in health
       • MI 3rd trimester and peripartum
         • Heamodynamic changes in full effect
           • higher risk of thrombotic events
             • hypercoagulability due to hormonal changes
         • present with ischeamic chest pain, abnormal ECG and elevated caridac enzymes
           • atypical features include abdominal or epigastric pain and vomiting
           • primary percutaneous transluminal coronary angiosplasty (PTCA) is first line treatment

4. Aortic Dissection

   • inked to severe hypertension
     • pre eclampsia, coarctation of aorta or connective tissue disease
       • presents as severe chest or intrascapular paind
         • early diagnosis required as mortality is high

5. Endocarditis

   • inflammation of endocardium
     • mainly valves. damaged
       • streptococcal infections main cause
         • valvular heart disease
           • previous history, periodontal disease, IV drug abuse
             • good infection control/ hygiene, avoid dental work.
               • antibiotic prophylaxis for high risk women

6. Peripartum Cardiomyopathy

   • rare. high mortality 25-50%
     • occurs in last month of pregnancy up to 5 months postpartum
       • sudden onset. no previous symptoms
         • enlargement and inflammation of myocardium
           • linked to myocarditis, viral infection, long term oral tocolytic therapy, cocaine abuse
             • treatment involves medication to decrease pulmonary congestion and fluid overload
               • oxygen, diuretics, vasodilators
               • inotrophic agents to improve myometrial contractability
           • left ventricular heart failure

7. Rheumatic Heart Disease

   • result of acute inflammatory complication
     • group A streptococcus
       • endocardium inflamed and scarred
         • mitral valve scarred. becomes distorted and dysfunctional
           • cusps of valves roughened
             • fuse together and narrow
               • mitral or atrial stenosis
                 • heart works harder to pump blood leading to hypertrophy
                   • heart increases in size
                     • weakens heart. pregnancy can cause failure
     • rare in UK. 25% of women not born in UK