Cardiology clinics
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The major adaptations of the maternal cardiovascular system that progress throughout gestation may unmask previously unrecognized heart disease and result in significant morbidity and mortality. Most of these changes are almost fully reversed in the weeks and months after delivery. Hemodynamic changes during pregnancy include increased blood volume, cardiac output (CO), and maternal heart rate; decreased arterial blood pressure; decreased systemic vascular resistance. CO increases up to 30% in the first stage of labor, primarily because of increased stroke volume; maternal pushing efforts in the second stage of labor can increase CO by as much as 50%.
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Chest pain syndromes in pregnancy include numerous catastrophic cardiovascular events. Acute myocardial infarction, aortic dissection, pulmonary embolism, and amniotic fluid embolism are the most important causes of nonobstetric mortality and morbidity in pregnancy. ⋯ However, their diagnosis and management is limited by fetal risks of diagnostic procedures, dangers of pharmacotherapy and interventions that have neither been widely studied nor validated. This article reviews the current literature on epidemiology, risk factors, pathogenesis, diagnosis, and management of 4 potentially lethal chest pain syndromes in pregnancy.
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Cardiac arrest in pregnancy is not only uncommon but also catastrophic. Early aggressive resuscitation by well-trained health care providers improves the chances of successful outcomes for both the patient and her fetus. Significant physiologic changes that occur normally in pregnancy require several modifications to standard cardiopulmonary resuscitation, and urgent cesarean delivery may be indicated to benefit both the mother and the infant.
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Hypertension in pregnancy is diagnosed on systolic blood pressure greater than or equal to 140 mm Hg and/or diastolic greater than or equal to 90 mm Hg. The classification systems separate chronic and gestational hypertension from preeclampsia. ⋯ Methyldopa, labetalol, hydralazine, and nifedipine are oral options; angiotensin-converting enzyme inhibitors and angiotensin receptor antagonists are contraindicated. Women with preeclampsia should be closely monitored and receive intravenous magnesium sulfate.