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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The pregnant woman is susceptible to a variety of respiratory complications. When a pregnant patient presents with an abnormal chest x-ray or a pulmonary complaint, an understanding of the pathophysiology of pregnancy will guide the clinician in establishing a diagnosis. Pregnancy brings about many changes to a woman's body. One of the more intriguing is a decrease in the T helper cells, resulting in a state of relative immunosuppression. Despite this, the prevalence of infectious pneumonia is not increased in pregnancy. Complications from pneumonia, however, are increased in the pregnant host. Most notably are increases in both mortality related to influenza infection and the risk for dissemination of coccidioidomycosis. Other physiologic changes predispose the pregnant woman to certain disease processes. Hypercoagulability associated with pregnancy results in a marked increase in the incidence of thromboembolic disease. Although rare, pregnancy is also associated with other embolic phenomena including amniotic fluid embolism, air embolism, and trophoblastic embolism. Because of the increases in intravascular volume and cardiac output that occur in pregnancy, women with underlying structural heart disease will frequently present for the first time or have an exacerbation of their disease. This is especially true of mitral stenosis. Peripartum cardiomyopathy also can occur, and for the majority of patients, the heart remains damaged for life. Finally, although uncommon, lymphangioleiomyomatosis will often present or become exacerbated during pregnancy. Patients with this disorder need to be counseled concerning the increased risk associated with pregnancy. This paper reviews the various respiratory complications associated with pregnancy.
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PMID:Respiratory complications of pregnancy. 1177 30

Congenital heart disease in pregnancy is increasingly common because of the advances in surgery and medical therapy which have taken place over the last 30 years, which means that more affected women are surviving into the reproductive age. Antenatal counselling needs to be tailored to the specific lesion, with pulmonary hypertension and cyanotic disease presenting a risk of maternal mortality of up to 50%. The use of anticoagulants in women with artificial valves presents a particular challenge, heparin being safer for the baby and warfarin for the mother. Peripartum cardiomyopathy and Marfan's syndrome may be less dangerous than once thought. The risk of congenital heart disease in the fetus is increased, from twice to 20-fold, depending on the nature of the mother's lesion. Care throughout pregnancy and in the puerperium should be multidisciplinary and include cardiologists, obstetricians and midwives with experience of such cases, preferably in a tertiary centre.
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PMID:Cardiac disease in pregnancy. 1191 90

Peripartum cardiomyopathy is a rare cardiac disorder characterized by the development of heart failure in the last month of pregnancy or up to 5 months postpartum in women without other determinable causes of cardiac failure. Intracardiac thrombi have been found at autopsy in some patients with this condition and have been demonstrated in the left or right ventricles on 2-dimensional echocardiography. A 23-year-old woman presented with peripartum cardiomyopathy and biventricular thrombi on echocardiography. The thrombi were spherical, pedunculate, shaggy and irregular in configuration, and freely mobile, suggesting that they were fresh. She was treated with conventional heart failure therapy and anticoagulants. Four days later, the apical thrombi within both ventricles had disappeared and there was no evidence of embolism on physical examination. The hypercoagulable state of the peripartum period and the severe biventricular dysfunction most likely led to the formation of biventricular thrombi.
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PMID:Peripartum cardiomyopathy and biventricular thrombi. 1222 27

Peripartum cardiomyopathy (PPCM) is a rare and serious heart disease that exclusively afflicts women during childbearing years. Symptoms include rapid onset of cardiovascular insufficiency occurring during pregnancy, initiated anytime between the third trimester until 5 months post-partum in the absence of any other signs or history of heart disease. The rare incidence of PPCM and the absence of any relevant animal models have limited research and understanding of the pathogenic mechanisms involved. Several compelling sets of data support the view that PPCM is a form of autoimmune IDCM. However, PPCM differs from autoimmune IDCM in that (a) it is associated with unique sets of autoantibodies and autoantigens, (b) it has a relatively rapid onset, and (c) it exclusively affects pregnant women. Furthermore, the etiology of PPCM is dependent on the interaction of pregnancy associated factors, e.g. increased hemodynamic stress, vasoactive hormones and fetal microchimerism, that co-operate in the context of essential immune and genetic environments for disease progression. Our model of PPCM attempts to represent how multiple factors, e.g. pregnancy, genetics, immune dysregulation, and fetal microchimerism are held in a complex dynamic balance that can co-operate towards the maintenance of cardiovascular health or disease in the mother (Fig. 1). A more thorough study of the precise nature of the cardiac tissue autoantigens may lead to the identification of the mechanisms of breakdown of self-tolerance and perhaps also the putative etiologic agent(s). Further studies of the precise nature of the cardiac tissue autoantigens and the specific factors governing the balance between tolerance and autoimmunity in the periphery, e.g. expression of PD-L1 on cardiac tissues and the role of regulatory T cells, may help to elucidate the autoimmune mechanisms of PPCM.
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PMID:Is peripartum cardiomyopathy an organ-specific autoimmune disease? 1284 62

Peripartum cardiomyopathy (CMP) represents an intriguing and incompletely characterised cause of heart failure arising in women without previously known heart disease during last trimester of pregnancy or first 20 weeks after birth. Fundamental clinical and basic research is lacking regarding this rare but potentially devastating disorder. The article reviews present accepted definition of CMP, epidemiological data, possible etiologic factors and pathogenic mechanisms proposed in CMP. It describes identified risk factors for CMP, clinical symptoms and signs, diagnostic assessment and treatment. Prognosis, follow up criteria and education for patients with previous CMP concerning subsequent pregnancies are also described.
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PMID:[Peripartum cardiomyopathy]. 1475 53

Peripartum cardiomyopathy (PPCM) is a rare cardiac disorder associated with high rates of mortality that occurs during the peripartum period. PPCM is recognized as a distinct entity, separate from preexisting cardiomyopathies that are worsened by the stressors of pregnancy. To date, its etiology is unknown, although several theories are under investigation in an effort to provide more information regarding available treatment options. A multidisciplinary review of PPCM held by the National Heart, Lung, and Blood Institute, in conjunction with the Office of Rare Disease of the National Institutes of Health, in April 1997 reviewed the current knowledge and developed recommendations for areas of further research and education about PPCM. Since then, there have been some promising research testing hypotheses regarding the etiology of PPCM and advancements in possible treatment options. However, despite these efforts, knowledge and treatment recommendations about PPCM are still generally unchanged, whereas mortality rates remain high. This article attempts to provide an updated, comprehensive review about PPCM and draw attention to areas in need of further research.
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PMID:Peripartum cardiomyopathy. 1637 64

Peripartum cardiomyopathy (PPCM) is a rare cardiac disorder of unknown cause that occurs in pregnant females, most commonly in the early postpartum period. It shares many clinical characteristics with idiopathic dilated cardiomyopathy but occurs at a younger age and is associated with a better prognosis. The etiology and pathogenic mechanisms have been difficult to study, however current hypotheses include infectious, immunologic, nutritional, and iatrogenic causes. Diagnosis is based upon the clinical presentation of congestive heart failure and objective evidence of left ventricular systolic dysfunction. Mortality rates over the past 10 years in PPCM have decreased, most likely due to advances in medical therapy for heart failure and use of implantable defibrillators. For those patients, who remain refractory to conventional pharmacologic therapy, cardiac transplantation and mechanical circulatory support are viable options. In less than 50% of PPCM patients, left ventricular function normalizes with pharmacologic therapy. However, subsequent pregnancies are often associated with recurrence of left ventricular systolic dysfunction.
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PMID:Peripartum cardiomyopathy. 1673 7

Background A 49-year-old woman presented at hospital, 8 days after giving birth to twins, with signs and symptoms of congestive heart failure. She had no history of heart disease, exposure to cardiotoxic agents or family history of heart muscle disease. Investigations Physical examination and laboratory blood tests, electrocardiography, transthoracic echocardiography. Diagnosis Peripartum cardiomyopathy. Management Standard heart failure therapy including beta-blockers, angiotensin-converting-enzyme inhibitors, diuretics and systemic anticoagulation.
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PMID:Management of a case of peripartum cardiomyopathy. 1693 69

Peripartum cardiomyopathy (PPCM) is a specific form of dilated cardiomyopathy, characterized by the development of systolic heart failure in the period between the last month of pregnancy and five months after delivery. It is a rare clinical condition of variable prognosis that occurs in the absence of identifiable cause or prior known heart disease. The authors report a clinical case of a previously healthy 33-year-old woman who developed de novo symptoms of progressively worsening heart failure in the 33rd week of gestation, that ended after two weeks in the development of cardiogenic shock and the need for emergency delivery.
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PMID:Peripartum cardiomyopathy: a case report. 1706 37

Peripartum cardiomyopathy is a rare and under recognized form of dilated cardiomyopathy, defined as a heart failure in the last month of pregnancy or in the first five months post-partum with absence of determinable cause for cardiac failure and absence of demonstrable heart disease. The incidence of peripartum cardiomyopathy ranges from 1 in 1300 to 1 in 15,000 pregnancy. Advanced maternal age, multiparity, twin births, preeclampsia and black race are known risk factors. The etiology of peripartum cardiomyopathy remains unknown but viral, autoimmune or idiopathic myocarditis are highly suggested. The clinical presentation on patients with peripartum cardiomyopathy is similar to that of patients with systolic heart failure. The treatment is based on drugs for sympyomatic control. Studies in graeter populations are need to determine the role of immunosupressive treatment. About half patients of peripartum cardiomyopathy recover. The left ventricular ejection fraction and the left ventricular end-diastolic diameter are statistically significant prognostic factors. The risk of developing peripartum cardiomyopathy in subsequent pregnancies remains high. The place of dobutamine stress test in counseling the patients who desire pregnancy must be more studied.
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PMID:[Peripartum cardiomyopathy]. 1707 64


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