Risk assessment, preconception counselling and management of cardiac disease

Question 1

Myocardial infarction, ischaemic heart disease, and aortic dissection

Answer 1

• 3/4 fold higher in pregnancy
• 10 times higher for pregnancy in > 40
• Maternal death from MI 1/132,000 pregnancies
• Risk factors: chronic hypertension, pre-eclampsia, diabetes, smoking, obesity and hyperlipidaemia
• 1/13 women of pregnant women with MI will die

Question 2

Peripartum cardiomyopathy

Answer 2

• Late pregnancy
• Early in the puerperium
• Up to 6 months after delivery
• Increasing SOB, especially at night, when lying flat

Question 3

Rheumatic heart disease

Answer 3

• Mitral valve stenosis most common

- Women not born in the UK

Question 4

Aortic dissection

Answer 4

• Systolic hypertension

- Most serious complication of marfan syndrome

Question 5

Congenital heart disease

Answer 5

• Prevalence in pregnancy 0.8%