Cardiac disease in pregnancy.

PURPOSE OF REVIEW: The past 15 years have seen a five-fold increase in the incidence of acquired heart disease as a cause of maternal mortality in the UK, and advances in the surgical correction of congenital heart disease have enabled many more women to survive childhood and present at the antenatal clinic. This review updates the reader on these important conditions.

RECENT FINDINGS: The major increased incidence of acute myocardial infarction during pregnancy has been attributed to an increasing proportion of older women having babies (risk 30-fold greater for women over 40 years compared with women under 20 years of age). The obesity epidemic is associated with increases in diabetes and hypertension. Percutaneous coronary intervention with stenting is the treatment of choice. Although aortopathies, cardiomyopathy and valvular heart disease present continuing problems, improvements in the management of pulmonary vascular disease (in particular, the use of sildenafil) have reduced mortality from this condition. Prophylaxis against endocarditis has been abandoned except for the highest risk cases.

SUMMARY: Cardiac disease in pregnancy is of growing importance both in terms of numbers of women affected and mortality. Improvements in care have occurred particularly in relation to ischaemic heart disease and pulmonary hypotension.