Pregnancy in arrhythmogenic cardiomyopathy (original) (raw)
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Pregnancy in inherited and acquired cardiomyopathies
Best practice & research. Clinical obstetrics & gynaecology, 2014
Cardiomyopathy encompasses a wide spectrum of heart muscle disease, which can have an impact on the patient's ability to sustain the increased cardiac workload of pregnancy. Pregnancy can also unmask previously unknown cardiomyopathy. The outcome for both mother and baby is often related to the patient's functional class prior to pregnancy, and a multidisciplinary approach to managing this challenging group of patients is pivotal.
Risk associated with pregnancy in hypertrophic cardiomyopathy
2003
We sought to assess mortality and morbidity in pregnant women with hypertrophic cardiomyopathy (HCM). BACKGROUND The risk associated with pregnancy in women with HCM is an important and increasingly frequent clinical issue for which systematic data are not available and a large measure of uncertainty persists. METHODS Maternal mortality in 91 consecutively evaluated families with HCM was compared with that reported in the general population. The study cohort included 100 women with HCM with one or more live births, for a total of 199 live births. Morbidity related to HCM during pregnancy was investigated in 40 women evaluated within five years of their pregnancy. RESULTS Two pregnancy-related deaths occurred, both in patients at a particularly high risk. The maternal mortality rate was 10 per 1,000 live births (95% confidence interval [CI] 1.1 to 36.2/1,000) and was in excess of the expected mortality in the general Italian population (relative risk 17.1, 95% CI 2.0 to 61.8). In the 40 patients evaluated within close proximity of their pregnancy, 1 (4%) of the 28 who were previously asymptomatic and 5 (42%) of the 12 with symptoms progressed to functional class III or IV during pregnancy (p Ͻ 0.01). One patient had atrial fibrillation and one had syncope, both of whom had already experienced similar and recurrent events before their pregnancy. CONCLUSIONS Maternal mortality is increased in patients with HCM compared with the general population. However, absolute maternal mortality is low and appears to be principally confined to women at a particularly high risk. In the presence of a favorable clinical profile, the progression of symptoms, atrial fibrillation, and syncope are also uncommon during pregnancy.
Pregnancy-Associated Cardiomyopathy
Circulation, 2005
Background— Cardiomyopathy associated with pregnancy was first described more than half a century ago. However, because of its rare occurrence and geographical differences, the clinical profile of this condition has remained incompletely defined. Methods and Results— Data obtained from 123 women with a history of cardiomyopathy diagnosed during pregnancy or the postpartum period were reviewed. One hundred women met traditional criteria of peripartum cardiomyopathy; 23 were diagnosed with pregnancy-associated cardiomyopathy earlier than the last gestational month. Peripartum cardiomyopathy patients had a mean age of 31±6 years and were mostly white (67%). Common associated conditions were gestational hypertension (43%), tocolytic therapy (19%), and twin pregnancy (13%). Left ventricular ejection fraction at the time of diagnosis was 29±11% and improved to 46±14% ( P ≤0.0001) at follow-up. Normalization of left ventricular ejection fraction occurred in 54% and was more likely in patie...
Cardiomyopathy in Pregnancy: A Review Literature
Heart Science Journal, 2021
Background : Pregnancy is a physiological process that many women can achieve. Pregnancy in asymptomatic patients with cardiomyopathy is usually well tolerated. However, regardless of the poor prognosis, breastfeeding cannot be accepted in the restricting form of cardiomyopathy. Prior heart events, inadequate results (NYHA with references class III or IV), or advanced left ventricular systolic dysfunction greatly increase the possibility of cardiac symptoms in pregnant women. In spite of intense medical care, clinical conditions can worsen during pregnancy. Although the incidence of cardiovascular disease is present 0.5-4% in developed countries, our knowledge about various cardiomyopathy and pregnancy should be updateable. Objective : Knowing each type of cardiomyopathy in pregnancy will help the doctor to provide a holistic approach to pregnant women Discussion : Peripartum cardiomyopathy in pregnancy is the most common type of cardiomyopathy; therefore, a thorough review is needed to give the best outcome for pregnancy. Arrhythmia is most prevalent in hypertrophic cardiomyopathy. Regular monitoring and therapeutic measures should be taken if the arrhythmia is life-threatening for the mother and child. The commonest form of restrictive cardiomyopathy in pregnancy is cardiac amyloidosis. Conclusion : Our literature provides three types of cardiomyopathies in pregnancy with an example condition for each type that is relevant during pregnancy.
2010
Background-Cardiomyopathy associated with pregnancy was first described more than half a century ago. However, because of its rare occurrence and geographical differences, the clinical profile of this condition has remained incompletely defined. Methods and Results-Data obtained from 123 women with a history of cardiomyopathy diagnosed during pregnancy or the postpartum period were reviewed. One hundred women met traditional criteria of peripartum cardiomyopathy; 23 were diagnosed with pregnancy-associated cardiomyopathy earlier than the last gestational month. Peripartum cardiomyopathy patients had a mean age of 31Ϯ6 years and were mostly white (67%). Common associated conditions were gestational hypertension (43%), tocolytic therapy (19%), and twin pregnancy (13%). Left ventricular ejection fraction at the time of diagnosis was 29Ϯ11% and improved to 46Ϯ14% (PՅ0.0001) at follow-up. Normalization of left ventricular ejection fraction occurred in 54% and was more likely in patients with left ventricular ejection fraction Ͼ30% at diagnosis. Maternal mortality was 9%. A comparison between the peripartum cardiomyopathy and early pregnancy-associated cardiomyopathy groups revealed no differences in age, race, associated conditions, left ventricular ejection fraction at diagnosis, its rate and time of recovery, and maternal outcome. Conclusions-This study helps to define the clinical profile of patients with pregnancy-associated cardiomyopathy diagnosed in the United States. Clinical presentation and outcome of patients with pregnancy-associated cardiomyopathy diagnosed early in pregnancy are similar to those of patients with traditional peripartum cardiomyopathy. These 2 conditions may represent a continuum of a spectrum of the same disease.
Pregnancy associated cardiomyopathy: Clinical profile in 137 patients diagnosed in the United States
Journal of The American College of Cardiology, 2003
Background-Cardiomyopathy associated with pregnancy was first described more than half a century ago. However, because of its rare occurrence and geographical differences, the clinical profile of this condition has remained incompletely defined. Methods and Results-Data obtained from 123 women with a history of cardiomyopathy diagnosed during pregnancy or the postpartum period were reviewed. One hundred women met traditional criteria of peripartum cardiomyopathy; 23 were diagnosed with pregnancy-associated cardiomyopathy earlier than the last gestational month. Peripartum cardiomyopathy patients had a mean age of 31Ϯ6 years and were mostly white (67%). Common associated conditions were gestational hypertension (43%), tocolytic therapy (19%), and twin pregnancy (13%). Left ventricular ejection fraction at the time of diagnosis was 29Ϯ11% and improved to 46Ϯ14% (PՅ0.0001) at follow-up. Normalization of left ventricular ejection fraction occurred in 54% and was more likely in patients with left ventricular ejection fraction Ͼ30% at diagnosis. Maternal mortality was 9%. A comparison between the peripartum cardiomyopathy and early pregnancy-associated cardiomyopathy groups revealed no differences in age, race, associated conditions, left ventricular ejection fraction at diagnosis, its rate and time of recovery, and maternal outcome. Conclusions-This study helps to define the clinical profile of patients with pregnancy-associated cardiomyopathy diagnosed in the United States. Clinical presentation and outcome of patients with pregnancy-associated cardiomyopathy diagnosed early in pregnancy are similar to those of patients with traditional peripartum cardiomyopathy. These 2 conditions may represent a continuum of a spectrum of the same disease.
Pregnancy and newborn outcomes in arrhythmogenic right ventricular cardiomyopathy/dysplasia
International Journal of Cardiology, 2018
The prognosis of pregnancy in patients with Arrhythmogenic Right Ventricular Cardiomyopathy/ dysplasia (ARVC/D) is poorly documented. The aim of this study is to assess the cardiac risks during pregnancy and the impact of ARVC/D on fetuses/neonates/children. Methods: We included all ARVC/D women with a history of pregnancy from the ARVC/D Pitié-Salpêtrière registry. Cardiac and obstetrical events having occurred during pregnancy/delivery/post-partum periods and neonatal data/follow-up were collected. Results: Sixty pregnancies in twenty-three patients were identified between 1968 and 2016. Only two major nonfatal cardiac events (one sustained non-documented tachycardia and one ventricular tachycardia) were recorded during pregnancy in two different mothers (3% of pregnancies, 9% of mothers). None occurred during delivery or in the postpartum period. No mother developed heart failure. Beta-blocker therapy during pregnancy (n = 15) was associated with lower birthweight (2730 vs 3400 g, p = 0.004). Only two preterm deliveries occurred, unrelated to cardiac condition. Caesarean section was performed in 13% of cases. Premature sudden-death occurred in 10% (n = 5) of children before 25 years-old including two in the first year of life. Conclusion: ARVC/D is associated with a low rate of major cardiac events during pregnancy and vaginal delivery appears safe. The risk of sustained ventricular arrhythmia seems poorly predictable and supports the continuation of beta-blockers during pregnancy. Major cardiac events were frequent in childhood, justifying close cardiac monitoring.
Journal of the American Heart Association, 2021
Background Arrhythmogenic cardiomyopathy (AC) is characterized by biventricular dysfunction, exercise intolerance, and high risk of ventricular tachyarrhythmias and sudden death. Predisposing factors for left ventricular (LV) disease manifestation and its prognostic implication in AC are poorly described. We aimed to assess the associations of exercise exposure and genotype with LV dysfunction in AC, and to explore the impact of LV disease progression on adverse arrhythmic outcome. Methods and Results We included 168 patients with AC (50% probands, 45% women, 40±16 years old) with 715 echocardiographic exams (4.1±1.7 exams/patient, follow‐up 7.6 [interquartile range (IQR), 5.4–10.9] years) and complete exercise and genetic data in a longitudinal study. LV function by global longitudinal strain was −18.8% [IQR, −19.2% to −18.3%] at presentation and was worse in patients with greater exercise exposure (global longitudinal strain worsening, 0.09% [IQR, 0.01%–0.17%] per 5 MET‐hours/week...
Pregnancy Complicated with Dilated Cardiomyopathy: A Case Report
Gynecology & Reproductive Health, 2020
Cardiomyopathy, a disease of the heart muscles, is difficult to manage and can lead to sudden cardiac death. Dilated cardiomyopathy, a form of cardiomyopathy, with recurrences in subsequent pregnancies, increases the morbidity and mortality of both mother and child. Here, we report a case of a 25-year-old woman with amenorrhea for 6 weeks and a history of dilated cardiomyopathy during her previous pregnancy. Despite the risks and associated complications with the disease, she willingly continued her pregnancy and underwent caesarian section giving birth to a premature alive baby. The aim of this case is to provide guidance on how to manage a patient with dilated cardiomyopathy throughout her pregnancy including antenatal, intranatal and postnatal care.