Heart disease in pregnancy

Heart disease is the leading cause of maternal mortality in the UK. Cardiomyopathy, myocardial infarction and aneurysm or dissection of the aorta are the leading causes of death from acquired heart disease while pulmonary hypertension is the leading cause of death from congenital heart disease. Congenital heart disease is the predominant form of heart disease encountered in pregnancy as most women with congenital heart disease now survive to adulthood due to the successes of paediatric cardiology and cardiac surgery. Patients with heart disease should receive multi-disciplinary counselling and risk assessment to enable an informed decision regarding pregnancy. Appropriate contraceptive advice should also be given. Physiological changes in pregnancy should be understood as they may precipitate decompensation in patients with previously well tolerated lesions. This article briefly reviews congenital and acquired cardiac lesions that are important because they are common conditions or because pregnancy poses a particular risk. Early involvement of a cardiologist is recommended in any pregnant woman with chest pain and ECG changes. Ischaemic heart disease and cardiomyopathy (dilated, peripartum, hypertrophic) are discussed. The management of pregnant women with prosthetic heart valves can be complex and choice of anti-coagulant needs to be individualised with close monitoring by a specialist team. Pregnancy is in-advisable in pulmonary hypertension, severe un-operated left sided stenosis, severely impaired ventricular function and Marfan syndrome with a dilated aortic root.