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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pregnancy causes substantial changes in the cardiovascular system: cardiac output (40%-50%) and blood volume (40%) increase whereas systemic peripheral resistance and arterial pressure decrease. The rise in progesterone and estrogen levels accompanying pregnancy stimulates the renin-angiotensin-aldosterone system. Increased prostaglandin production follows renin activation; simultaneously, the arterial vessels show diminished angiotensin sensitivity. The result is pronounced vasodilatation. Cardiovascular diseases remain the most important nonobstetric cause of maternal death. The physiological changes in the cardiovascular system during pregnancy influence cardiac diseases in different ways. Pregnancy, labor, and delivery appear to be well tolerated in gravidae with an atrial septal defect, ventricular septal defect, and patent ductus arteriosus. Sometimes congestive heart failure occurs and appropriate medical therapy is necessary. Pregnant women with uncorrected cyanotic congenital heart disease (Eisenmenger's syndrome, tetralogy of Fallot) constitute a high-risk group because of right ventricular insufficiency and hypoxic attacks. The consequences for anaesthesia in parturients with congenital heart disease are discussed. The symptoms of acquired mitral or aortic stenosis are aggravated by the physiological changes in the cardiovascular system during pregnancy; the clinical symptoms of valve insufficiency are ameliorated by vasodilatation. Peripartum cardiomyopathy clinically shows similar features to idiopathic dilated cardiomyopathy. The basis of treatment is the same as that of congestive heart failure, with the therapeutic spectrum ranging from diet to heart transplantation. Women with hypertrophic cardiomyopathy tolerate pregnancy, labor, and delivery surprisingly well. Vaginal delivery is possible, but epidural anaesthesia is contraindicated. Hypertensive disorders associated with pregnancy are classified into three groups: chronic, transient, and pre-eclamptic hypertension. Whereas chronic and transient hypertension do not affect the outcome of pregnancy appreciably, pre-eclampsia presents a potential danger to mother and fetus. Pre-eclamptic hypertension is accompanied by low cardiac output and plasma volume. An upregulation of angiotensin receptors enhances vascular reactivity, with the consequence of high peripheral resistance. For antihypertensive therapy hydralazine, alpha-methyldopa, and magnesium sulfate are the drugs of choice. A generalised recommendation of anaesthesia for the pre-eclamptic gravida cannot be made because both general and epidural anaesthesia have risks of severe side effects.
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PMID:[Cardiovascular diseases during pregnancy. Considerations for the anesthesiologist]. 765 90

Peripartum cardiomyopathy is an under-recognized form of dilated cardiomyopathy of unknown cause and is associated with excess morbidity and mortality in women of childbearing age. Incidence of peripartum cardiomyopathy ranges from 1 in 1,300 to 1 in 15,000 pregnancies. The diagnostic criteria are onset of heart failure in the last month of pregnancy or in first 5 months postpartum, absence of determinable cause for cardiac failure, and absence of a demonstrable heart disease before the last month of pregnancy. Multiparity, twin births, advanced maternal age, preeclampsia, gestational hypertension, and black race are known risk factors. The exact cause of peripartum cardiomyopathy is unclear. The clinical presentation of patients with peripartum cardiomyopathy is similar to that of patients with systolic congestive heart failure. Little is known about the therapy of this disease, and the medical treatment is limited to the use of drugs for symptomatic control. Prospective, randomized, double-blind studies are needed to define the role of immunosuppressive treatment and to evaluate the role of conventional treatment of dilated cardiomyopathy in reducing the mortality rate of peripartum cardiomyopathy. About half the patients of peripartum cardiomyopathy recover without any complications. The prognosis is poor in patients with persistent cardiomyopathy. Persistence of disease after 6 months indicates irreversible cardiomyopathy and portends worse survival. The risk of developing peripartum cardiomyopathy in subsequent pregnancies remains high. The clinical and therapeutic aspects of the peripartum cardiomyopathy are discussed.
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PMID:Peripartum cardiomyopathy: clinical and therapeutic aspects. 1171 28

Peripartum cardiomyopathy is a rare disorder with an incidence from 1:3,000 to 1:15,000 live births and thus not often described in the anaesthesiology literature. The etiology of this disease is still not known but the symptoms are similar to idiopathic dilated cardiomyopathy. Echocardiographic findings show a dilatation of the left ventricle in addition to abnormal wall motion with a severe reduction of the cardiac function. Despite the rarity of this disorder, the anaesthesiologist or ICU physician should consider peripartal cardiomyopathy as a differential diagnosis to ensure an adequate perioperative management. There seems to be an increased incidence in pregnant women who are elderly (age >30 years),who have a history of gestosis/hypertension,have a gemini pregnancy or are of black origin. The prognosis depends on the recovery of the left ventricular contractility within the first 6 months after onset of the disease. The mortality rate is reported to vary between 25% and 50%. Heart transplantation is regarded as the last resort which has successfully been performed with several patients. This case describes the perioperative management of a 32-year-old women with peripartum cardiomyopathy.
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PMID:[Peripartum cardiomyopathy. Perioperative anaesthesiological management of a rare complication of pregnancy]. 1262 99

The incidence of congestive heart failure in the US population is increasing as more women and men survive with chronic hypertensive and atherosclerotic heart disease. Almost half the patients in the US with heart failure are women. Hypertension, diabetes mellitus, and cigarette smoking are all more potent risk factors for the development of heart failure in women than in men. Important differences in presentation and mortality explain gender differences in the clinical course of heart failure. Overall mortality is lower for women than for men with symptomatic heart failure. Some but not all of this difference can be explained by a lower rate of ischemic heart disease. Standard treatments for congestive heart failure, including angiotensin converting enzyme inhibitors and beta-blockers, have been shown to be equally efficacious in men and in women. Preliminary data on angiotensin II receptor blockers suggests equivalent benefit with further trial data awaited. Peripartum cardiomyopathy is a form of heart failure unique to women, occurring in the last stages of pregnancy or within 5 months after delivery. Approximately half of affected women regain normal ventricular function but for those who do not, the risk of recurrent symptomatic heart failure and mortality during subsequent pregnancies is high.
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PMID:Heart failure in women. 1458 Mar 3

Peripartum cardiomyopathy is rare in developped countries, but still frequent in Africa. It is defined as a heart failure occurring during peripartum, without any underlying etiology. Authors present 3 cases showing that heart failure before or after delivery may be due to causes which are frequent in the Sahelian area but generally misdiagnosed. Anemia, hypertension and rheumatic fever were the causes of heart failure in these 3 patients, but they were not apparent when the initial diagnosis was made. These observations emphasize that, despite the complex hypothesis trying to explain heart failure during the peripartum period, one should think about some frequent causes which can be misdiagnosed because of the pregnant state or the heart failure itself.
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PMID:[Peripartum heart failure: the underestimated role of frequent diseases in the Sudan-Sahelian area]. 1577 67

Peripartum cardiomyopathy creates complications for 1 in 3000 to 4000 pregnant women in the US. As this rare condition is associated with a high mortality rate (50% to 85%), it has been investigated to define the possible associated causes. Several factors including hypertension, nutritional and dietary discrepancies, and, recently, myocarditis are being implicated, but the mechanism of cardiac injury is yet to be discovered. Here we present an interesting case of possible interferon-induced reversible peripartum cardiomyopathy. The patient, with a diagnosis of chronic myelogenous leukemia, had been given interferon for 6 years. The therapy was discontinued when she became pregnant, and later she presented with symptoms of heart failure 6 weeks after her c-section. Interferon is an immunomodulating agent and used as an antiviral and an anticancer agent. Interferon-related dilated cardiomyopathy has been described as a rare side effect of the drug, the mechanism of which is unknown. There is compelling data supporting the fact that both peripartum cardiomyopathy and interferon-related cardiomyopathy are autoimmune disorders; so it is suggested that interferon therapy given in the past can have an additive effect in causing dilated cardiomyopathy. It is therefore advisable to follow closely those pregnant patients; who received interferon therapy in the past, for symptoms of cardiac failure, as there can be synergistic action between interferon and pregnancy causing dilated cardiomyopathy.
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PMID:Reversible peripartum cardiomyopathy in a patient with prior exposure to interferon. 1685 74

Peripartum cardiomyopathy (PPCM) is a rare disorder in which left ventricular dysfunction and symptoms of heart failure occur in the peripartum period in previously healthy women. Incidence of PPCM ranges from 1 in 1300 to 1 in 15,000 pregnancies. The etiology of PPCM is unknown, but viral, autoimmune, and idiopathic causes may contribute. The diagnostic criteria are onset of heart failure in the last month of pregnancy or in first 5 months postpartum, absence of determinable cause for cardiac failure, and absence of a demonstrable heart disease before the last month of pregnancy. Risk factors for PPCM include advanced maternal age, multiparity, African race, twinning, gestational hypertension, and long-term tocolysis. The clinical presentation of patients with PPCM is similar to that of patients with dilated cardiomyopathy. Early diagnosis and initiation of treatment are essential to optimize pregnancy outcome. Treatment is similar to medical therapy for other forms of dilated cardiomyopathy. About half the patients of PPCM recover without complications. The prognosis is poor in patients with persistent cardiomyopathy. Persistence of disease after 6 months indicates irreversible cardiomyopathy and portends worse survival.
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PMID:Peripartum cardiomyopathy: a comprehensive review. 1805 91

Peripartum cardiomyopathy (PPCM) is a rare, idiopathic, life-threatening disease of late pregnancy and early puerperium, occurring in patients with previously healthy hearts. Risk factors include multiparity, age>30 years, African American race, multiple pregnancies, obesity, hypertension, and toxemia. Signs and symptoms of PPCM resemble systolic heart failure, and it is diagnosed by exclusion. An echocardiogram typically reveals an ejection fraction of <45% and/or fractional shortening of <30%, along with a left ventricular end-diastolic dimension>2.7 cm/m2 of body surface area. Early diagnosis and treatment are important for a successful outcome. Management is similar to other forms of systolic heart failure. Patients with PPCM are at high risk of thromboembolism, and therefore anticoagulation therapy should be considered. The prognosis is variable, ranging from complete recovery, to worsening heart failure requiring cardiac transplantation, or death. Future pregnancies are often discouraged because of the high mortality rate and risk of recurrence.
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PMID:Peripartum cardiomyopathy. 1846 6

Peripartum cardiomyopathy (PPCM) is a rare disorder in which left ventricular dysfunction and symptoms of heart failure occur in the peripartum period in previously healthy women. Incidence of PPCM ranges from 1 in 1300 to 1 in 15,000 pregnancies. The etiology of PPCM is unknown, but viral, autoimmune, and idiopathic causes may contribute. The diagnostic criteria are onset of heart failure in the last month of pregnancy or in the first 5 months postpartum, absence of determinable cause for cardiac failure, and absence of a demonstrable heart disease before the last month of pregnancy. Risk factors for PPCM include advanced maternal age, multiparity, African race, twinning, gestational hypertension, and long-term tocolysis. The clinical presentation of patients with PPCM is similar to that of patients with dilated cardiomyopathy. Echocardiography is central to diagnosis. Early diagnosis and initiation of treatment are essential to optimize pregnancy outcome. Treatment is similar to medical therapy for other forms of dilated cardiomyopathy. About half the patients of PPCM recover without complications. The prognosis is poor in patients with persistent cardiomyopathy. Persistence of disease after 6 months indicates irreversible cardiomyopathy and portends worse survival.
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PMID:[Peripartum cardiomyopathy]. 1859 37

Peripartum cardiomyopathy is a potentially fatal form of heart failure associated with pregnancy. A 29-year-old African American woman, gravida 3, para 2, at 36 weeks' gestation had a history of cardiomyopathy, morbid obesity (body mass index > 70 kg/m2), uncontrolled hypertension, obstructive sleep apnea, and required a repeat cesarean delivery. The patient was admitted to the hospital several times throughout her pregnancy for congestive heart failure, pulmonary edema, and headaches. Two years previously the patient received a diagnosis of peripartum cardiomyopathy 3 weeks after the delivery of her second child. This case report illustrates the recognition of peripartum cardiomyopathy and the risks early in pregnancy. It also describes the appropriate medical management, including transesophageal echocardiography and the need for collaboration of multiple medical specialists before and during delivery to provide the best possible outcome for both mother and infant.
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PMID:Multidisciplinary management of peripartum cardiomyopathy during repeat cesarean delivery: a case report. 1909 Mar 14


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