Cardiac Disease in Pregnancy

Question 1

• Discuss CO changes in the pregnant patient with a transplanted heart.

Answer 1

• The increase in CO results from an increase in SV rather than HR as these hearts are denervated.

Question 2

• Discuss the risk of rejection of the transplanted heart and mgmt of anti-rejection drugs during pregnancy.

Answer 2

• The risk of rejection is not increased during pregnancy.
• Immunosuppressants should be kept at the lowest possible doses during pregnancy (as they increase the risk of infection).

Question 3

• In pregnant patients with a transplanted heart and a valvulopathy, when should IE prophylaxis be given if undergoing vaginal delivery?

Answer 3

• At rupture of membranes.