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Dyspnea and palpitation
during pregnancy
PREPARED BY
FARAIDWN MUHAMMAD
Contents
• Objective
• Physiological changes
• Differential diagnosis
• What help in history & examination
• Management
• ...
Objective
• To evaluate the common causes of dyspnea & palpitation
during pregnancy
• How history, examination & investiga...
Introduction
• Breathlessness ( Dyspnea ) / shortness of breath /difficult,
laboured , consciousness about taking breath i...
Common differential diagnosis
• Physiological changes occurs in pregnancy
• Heart disease in pregnancy
• Respiratory disea...
Physiological changes in
pregnancy
1. ↑ in plasma volume
2. ↑ Red cell mass
3. Peripheral vasodilation, an ↑in HR, and a f...
Anatomical changes
• Diaphragm elevation by gravid uterus
• Heart displace upward and to left side .
• CXR show increased ...
Sign & symptom of normal pregnancy
mimic heart disease
• Dizziness
• Dyspnea
• Easy fatigability
• ↑in heart rate
• Edema
...
What in history help in diagnosis
• Duration & Severity of symptoms
• Presence of: fever –cough-sweating -→ resp. disease
...
• Medication intake like for thyroid – asthma
Anticoagulants –others
• Obstetrical history
G P A LMP EDD GA
Mode of delive...
What in examination help
General:
PR & pressure, BP, RR, Temp , edema, cyanosis, exophthalmos
Scar, dilated neck vein
4th ...
Heart disease and pregnancy
Pre conceptional counselling
• Full assessment
• Treatment of any concurrent medical problem
•...
NYHA (New York Heart Association)
Functional grading of heart disease
Grade I: No limitation of physical activity- asympto...
Toronto risk markers of maternal
cardiac complications
Criteria Points
Prior cardiac events 1
NYHA III/IV or cyanosis 1
Va...
Contraindications of pregnancy
• Marfan syndrome with dilated aortic root
• NYHA class 3 & 4 heart failure
• Eisonmenger s...
Fetal risks of maternal cardiac disease
• Recurrence (congenital heart disease)
• Fetal hypoxia (Maternal cyanosis)
• Pret...
Case scenario
Sana is 29 years old had history of heart disease, attend
ANC at her 14 weeks of gestation
• Need team work management
• The main aims of management are:
early risk assessment, optimization, regular monitoring for...
Symptoms of heart disease
• Hypertension
• Chest discomfort, hemoptysis & cough
• Progressive dyspnea, orthopnea or dys. a...
Clinical findings of heart disease
• Cyanosis
• Clubbing
• Persistent neck vein distention
• Diastolic murmur
• Loud, hars...
What investigations should done
• ECG
• Echocardiography
• Chest X-ray
• Cardiac MRI (dx and px)
• US scan for dating –IUGR
Risk factors for developing heart failure
• Anemia
• Hypertension
• Cardiac arrhythmia
• Pre eclampsia
• Infection
• Over ...
• Team approach
• Activity restrictions
• Diet modifications
• Infection control
◦ Immunizations, SBE prophylaxis, prophyl...
Case scenario
B is G2 P 0 A1 at 39 week, present to labor room in active
labor she is known case of MVD
Management of labour and delivery
• Spontaneous vaginal delivery
• Cesarean section is only indicated for obstetric causes...
Management of labour and delivery
• Sitting position supported with pillow
• Oxygen, diuretic, digoxin, B blocker & antiar...
Case scenario
Sana is G4 P3 AO she was well up to 34 wk develop CHF
what is your management?
Peripartum Cardiomyopathy
Symptoms of CHF that become apparent in last month of
pregnancy or within 5 months postpartum wi...
• 1 in 10 000
• Multiparous, ˃ 35 yr
• Peak incidence in 3rd trimester
• 50% mortality
• Atherosclerosis is infrequent cau...
Family planning
• Small family is advised
• Barrier
• POP
• Sterilization by tubal ligation
• IUCD is contraindicated beca...
Conclusion
• Heart disease is serious condition & it is non obstetrical
causes for maternal mortality
• It need team work
...
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Dyspnea and palpitation durnig pregnancy

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This presentation describes the common causes of shortness of breath during pregnancy and their approach

Publié dans : Santé & Médecine
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Dyspnea and palpitation durnig pregnancy

  1. 1. Dyspnea and palpitation during pregnancy PREPARED BY FARAIDWN MUHAMMAD
  2. 2. Contents • Objective • Physiological changes • Differential diagnosis • What help in history & examination • Management • Family planning • Conclusion
  3. 3. Objective • To evaluate the common causes of dyspnea & palpitation during pregnancy • How history, examination & investigation help in diagnosis • Plan for delivery • Contraception & family planning
  4. 4. Introduction • Breathlessness ( Dyspnea ) / shortness of breath /difficult, laboured , consciousness about taking breath is a common symptom during pregnancy. • May be related to physiological changes in cardio- pulmonary, hemopoetic system, increase in weight, hormonal stimulation, etc.
  5. 5. Common differential diagnosis • Physiological changes occurs in pregnancy • Heart disease in pregnancy • Respiratory disease in pregnancy • Anemia • Thyroid disorder • Drug (NSAIDs, Amiodarone) • Psychological– anxiety, fear
  6. 6. Physiological changes in pregnancy 1. ↑ in plasma volume 2. ↑ Red cell mass 3. Peripheral vasodilation, an ↑in HR, and a fall in systemic & pulmonary resistance 4. ↑ C.O.P 40% & stroke volume
  7. 7. Anatomical changes • Diaphragm elevation by gravid uterus • Heart displace upward and to left side . • CXR show increased C/T ratio (apparent cardiomegaly)
  8. 8. Sign & symptom of normal pregnancy mimic heart disease • Dizziness • Dyspnea • Easy fatigability • ↑in heart rate • Edema • Syncope
  9. 9. What in history help in diagnosis • Duration & Severity of symptoms • Presence of: fever –cough-sweating -→ resp. disease • Sweating- lose of appetite –anxiety -→ thyroid disease • PND –dyspnea on exertion –chest pain -→ heart disease • History of:- familial disease like asthma rheumatic fever in childhood any cardiac problem and surgery
  10. 10. • Medication intake like for thyroid – asthma Anticoagulants –others • Obstetrical history G P A LMP EDD GA Mode of delivery in previous pregnancy --- Medications admission to ICU
  11. 11. What in examination help General: PR & pressure, BP, RR, Temp , edema, cyanosis, exophthalmos Scar, dilated neck vein 4th heart sound –murmurs Para sternal thrill Basal crepitation & scattered rhonchi Obstetrical examination (Fundal height) ◦
  12. 12. Heart disease and pregnancy Pre conceptional counselling • Full assessment • Treatment of any concurrent medical problem • Discussing the risks for both (mother & fetus) • Cardiac risk varies among specific forms of heart disease Some diseases negligible, some prohibitive
  13. 13. NYHA (New York Heart Association) Functional grading of heart disease Grade I: No limitation of physical activity- asymptomatic with normal activity Grade II: Mild limitation of physical activity -Symptoms with normal physical activity Grade III: Marked limitation of physical activity -Symptoms with less than normal activity, comfortable at rest Grade IV: Severe limitation of physical activity- symptoms at rest
  14. 14. Toronto risk markers of maternal cardiac complications Criteria Points Prior cardiac events 1 NYHA III/IV or cyanosis 1 Valvular and outflow tract obstruction 1 Myocardial dysfunction 1 * Maternal cardiac event rate for 0, 1, and >1 points is 5%, 37%, and 75%, respectively.
  15. 15. Contraindications of pregnancy • Marfan syndrome with dilated aortic root • NYHA class 3 & 4 heart failure • Eisonmenger syndrome (maternal mortality is 40%) • Peripartum CMP • Severe uncorrected valvular stenosis • Primary pulmonary hypertension • Coarctation of aorta
  16. 16. Fetal risks of maternal cardiac disease • Recurrence (congenital heart disease) • Fetal hypoxia (Maternal cyanosis) • Preterm labour • FGR • Effects of maternal drugs (teratogenesis, growth restriction, fetal loss)
  17. 17. Case scenario Sana is 29 years old had history of heart disease, attend ANC at her 14 weeks of gestation
  18. 18. • Need team work management • The main aims of management are: early risk assessment, optimization, regular monitoring for deterioration, planning of delivery, and surveillance for deterioration in the immediate post-partum period. Antenatal management
  19. 19. Symptoms of heart disease • Hypertension • Chest discomfort, hemoptysis & cough • Progressive dyspnea, orthopnea or dys. at night • Palpitations & change in heart rate • Syncope • Fatigue & exercise intolerance • Edema • A past history of congenital or acquired heart disease. • A family history of congenital heart disease.
  20. 20. Clinical findings of heart disease • Cyanosis • Clubbing • Persistent neck vein distention • Diastolic murmur • Loud, harsh systolic murmurs • Persistent split 2nd sound • Sustained cardiac arrhythmias • Cardiomegaly • Pulmonary hypertension
  21. 21. What investigations should done • ECG • Echocardiography • Chest X-ray • Cardiac MRI (dx and px) • US scan for dating –IUGR
  22. 22. Risk factors for developing heart failure • Anemia • Hypertension • Cardiac arrhythmia • Pre eclampsia • Infection • Over work • Over weight • Tocolytics
  23. 23. • Team approach • Activity restrictions • Diet modifications • Infection control ◦ Immunizations, SBE prophylaxis, prophylaxis against rheumatic fever • Use of anticoagulants Warfarin or heparin from 6-12 weeks of gestation or throughout pregnancy
  24. 24. Case scenario B is G2 P 0 A1 at 39 week, present to labor room in active labor she is known case of MVD
  25. 25. Management of labour and delivery • Spontaneous vaginal delivery • Cesarean section is only indicated for obstetric causes • Warfarin should be discontinued and substituted with heparin for 10 days before delivery • Warfarin is recommenced 2-3 days postpartum
  26. 26. Management of labour and delivery • Sitting position supported with pillow • Oxygen, diuretic, digoxin, B blocker & antiarrhythmic drugs • Analgesic (morphine ,epidural anesthesia) • Prophylactic antibiotics • Shortening of the 2nd stage by elective forceps & vacuum • oxytocin • Anticoagulant
  27. 27. Case scenario Sana is G4 P3 AO she was well up to 34 wk develop CHF what is your management?
  28. 28. Peripartum Cardiomyopathy Symptoms of CHF that become apparent in last month of pregnancy or within 5 months postpartum with no pre- existing disease and no other etiology for heart failure Tx: Digoxin and diuretics Hydralazine Anticoagulation
  29. 29. • 1 in 10 000 • Multiparous, ˃ 35 yr • Peak incidence in 3rd trimester • 50% mortality • Atherosclerosis is infrequent cause (Coronary spasm, in situ coronary thrombosis, and coronary artery dissection) • Treatment of MI same as non-pregnant treatment Ischemic Heart Disease
  30. 30. Family planning • Small family is advised • Barrier • POP • Sterilization by tubal ligation • IUCD is contraindicated because it may cause infective endocarditis • COCP are contraindicated because it contain estrogen that cause fluid retention
  31. 31. Conclusion • Heart disease is serious condition & it is non obstetrical causes for maternal mortality • It need team work • Close observation throughout pregnancy

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