ABSTRACT
Importance of cardiac disease in pregnancy 341 Physiologic changes in pregnancy 341 Symptoms and signs of cardiac disease 342 Investigations in pregnancy 342 Effect of pregnancy on heart disease 343
Effect of heart disease on pregnancy 343 Etiology 344 General management 344 Specific conditions 344 References 358
Cardiac disease in pregnancy is relatively rare in the United Kingdom, United States, and other developed countries, although still common in developing countries. Disease patterns are changing in the former, with a decline in rheumatic heart disease, but an increase in congenital and ischemic heart disease. Women with congenital heart disease are now surviving into adulthood, after corrective surgery as children, with the potential for childbearing, but often more complicated pregnancies. Increasing maternal age, as well as rising rates of cigarette smoking, obesity, and diabetes among women, means ischemic heart disease is encountered more frequently.
