Contemporary Topics in Cardio-Obstetrics (Contemporary Cardiology)

Preface
Acknowledgements
Contents
Chapter 1: Trends in Maternal Morbidity and Mortality
	Maternal Mortality in the United States—Recent Trends
	Trends in Cardiovascular Disease
	Maternal Mortality Related to COVID-19
	Racial and Ethnic Disparities
	Trends in Adverse Pregnancy Outcomes
	Importance of Cardio-Obstetrics Training
	Implications of the Overturning of Roe v. Wade on Maternal Mortality
	References
Chapter 2: Health Disparities
	Maternal Health Disparities and Cardiovascular Disease
	Disparities in Preconception CVD Risk Factors
		Hypertension
		Diabetes
		Overweight/Obesity
		Physical Activity
		Smoking
	Disparities in CVD in Pregnancy
		Maternal Mortality Related to Cardiovascular Conditions
		Maternal Morbidity Related to Cardiovascular Conditions
		Major Cardiovascular Events
		Pulmonary Hypertension (PH)
		Peripartum Cardiomyopathy
	Disparities in Cardiometabolic Complications of Pregnancy and their CVD-Related Sequelae
		Hypertensive Disorders of Pregnancy
		Preterm Birth
		Gestational Diabetes Mellitus
	Summary and Discussion
	References
Chapter 3: Normal Physiology of Pregnancy and Labor
	Introduction
	Cardiovascular Changes
	Hematologic Changes
	Uteroplacental Circulation
	Respiratory Changes
	Renal and Urinary Tract Changes
	Gastrointestinal Changes
	Endocrine Changes
	Parturition
	References
Chapter 4: CVD Risk Factors
	Introduction
	Obesity
		Associated Maternal and Fetal Risks
		Management
	Sleep Apnea
		Associated Maternal and Fetal Risks
		Management
	Pre-gestational Diabetes Mellitus
		Associated Maternal and Fetal Risks
		Management
	Chronic Hypertension in Pregnancy
		Associated Maternal and Fetal Risks
		Management of Chronic Hypertension
		Acute Management of Severe-Range Hypertension in Pregnancy
	Tobacco Use in Pregnancy
	Hyperlipidemia in Pregnancy
		Management of Hyperlipidemia
	Exercise in Pregnancy
		Associated Maternal and Fetal Benefits
		Contraindications to Exercise in Pregnancy
	Conclusions
	References
Chapter 5: Diabetes and Pregnancy
	Preconception Care
	Pregnancy
		Physiology, Changes in Glycemia, and Insulin in Pregnancy
		Insulin Use in Preexisting Diabetes
		Goals and Monitoring, Insulin Dosing
		Oral Medications: Metformin, Glyburide
		Diabetes Complications
		Maternal Concerns During Pregnancy
			Hypertension
			Preeclampsia
			Cardiovascular Disease
			Delivery Considerations
		Fetal Concerns
			Miscarriage and Malformation
			Preterm Delivery
			Macrosomia
			Fetal Demise
		Intrapartum, Management During Delivery
	Postpartum
		Glycemic Changes, Medical Management
		Breastfeeding
		Contraception
	References
Chapter 6: Breastfeeding
	Fetal and Maternal Benefits of Breastfeeding
	Physiology of Breastfeeding
	Special Considerations for Women with Cardiac Disease and Breastfeeding
	Principles of Determining Safety of Breastfeeding and General Approach to Cardiovascular Medications in Pregnancy and Breastfeeding
		Anticoagulants
		Antiplatelet Agents and Dual Antiplatelet Therapy
	Hypertension and Heart Failure
	Statins and Lipid-Lowering Agents
	Anti-arrhythmic Drugs
	Diagnostic Imaging
	Conclusion
	References
Chapter 7: Cardiac Anesthesia and Delivery Considerations in Cardiac Patients
	An Approach to Multidisciplinary Delivery Planning
	Delivery Planning for Patients with Cardiovascular Disease of Average Risk
		Mode of Delivery
		Analgesia and Monitoring
	Delivery Planning for Patients with Cardiovascular Disease of Increased Risk
		Mode of Delivery
		Analgesia and Monitoring
	Delivery Planning for Patients with Cardiovascular Disease at Highest Risk
		Mode of Delivery
		Analgesia and Monitoring
	Additional Procedural Considerations for Pregnant Patients with CVD
		Emergent Obstetric and Non-Obstetric Surgery
		Termination of Pregnancy
	Preparation and Planning for Commonly Encountered Peripartum Scenarios
		Obstetric Hemorrhage
		Pulmonary Edema
		Decompensated Heart Failure
		Arrhythmias and Cardiac Arrest
	Optimizing Maternal Outcomes on Labor and Delivery
	References
Chapter 8: The Fourth Trimester: Adverse Pregnancy Outcomes and Long-Term Cardiovascular Risk
	Introduction
	Adverse Pregnancy Outcomes and the Development of Cardiac Risk Factors
		Hypertension
		Obesity
		Type 2 Diabetes Mellitus
		Dyslipidemia
		Chronic Kidney Disease
	Adverse Pregnancy Outcomes and Cardiovascular Disease
		Hypertensive Disorders of Pregnancy
		Gestational Diabetes
		Spontaneous Preterm Delivery
		Small for Gestational Age
		Miscarriage and Stillbirth
	Potential Mechanisms Linking APOs to Future Cardiovascular Disease
		Endothelial Dysfunction
		Cardiovascular Structure and Function
		Genetic Predisposition
		Development of Cardiovascular Risk Factors
		Inflammation
		Cellular Senescence
	Interventions to Mitigate Future Cardiovascular Risk
		Lifestyle Modification
		Lactation
		Pharmacotherapy
	Utilizing APOs for Cardiovascular Risk Stratification
	Improving Postpartum Transitions of Care
	Disparities in APOs and Future Cardiovascular Disease
	Conclusions
	References
Chapter 9: Preeclampsia in Pregnancy: Diagnosis, Management, and Future Implications for Maternal Health
	Definitions and Diagnosis
	Epidemiology
	Pregnancy Management
		Chronic Hypertension
		Gestational Hypertension
		Preeclampsia
		Hypertensive Urgency
			Pre- and Periviable Preeclampsia
			Postpartum Preeclampsia
			Eclampsia
			Preeclampsia Imitators
	Management of Subsequent Pregnancies
	Long-Term Implications of Preeclampsia and Prevention
	Preeclampsia and Health Equity
	References
Chapter 10: Preeclampsia: Effects on Cardiovascular Outcomes
	Introduction
	Pathophysiology of Preeclampsia and CVD
	Preeclampsia: Acute Cardiovascular Dysfunction
		Clinical Changes
		Acute Heart Failure: (Systolic and Diastolic)
		Stroke
		Myocardial Infarction
	Preeclampsia and Long-Term CVD Outcomes
		Association with Cardiovascular Risk Factors
		Coronary Artery Disease
		Heart Failure
		Overall CVD and Associated Mortality
	Potential Interventions
		Current Practices
		Opportunities for Risk Identification and Management
		Postpartum Management
	Preeclampsia and Effects on Children
		Perinatal/Infants
		Hypertension and Other CVD Risk Factors
		Cognitive Changes
		Future Recommendations
	Conclusions
	References
Chapter 11: Maternal Stroke
	Epidemiology and Pathophysiology
		Epidemiology
		Intrinsic Risk Factors for Ischemic Stroke
		Extrinsic Risk Factors for Ischemic Stroke
		Labor and Delivery Considerations
		Disparities
	Stroke Workup
		History and Physical Exam
		Tests
		Imaging
			Emergent Imaging Techniques for Acute Stroke
			Cerebral Blood Vessel Imaging Techniques
			Other Imaging Considerations
	Treatment and Therapies
		Rapid Treatment in Acute Ischemic Stroke
		Secondary Prevention of Ischemic Stroke
	Conclusion
	References
Chapter 12: Peripartum Cardiomyopathy
	Introduction
		Defining PPCM
		Evaluating for PPCM
	Risk Factors for PPCM
	Diagnosing PPCM
		Managing PPCM
	Preferred Therapies
	Medications to Avoid
	Adjunctive Therapy Specific to PPCM
	Treatment of PPCM with Hemodynamic Instability and Cardiogenic Shock
	Labor and Delivery
	Long-Term Risk Modification
	Conclusions
	References
Chapter 13: Hypertrophic Cardiomyopathy
	Hypertrophic Cardiomyopathy
	Pathophysiology Related to Pregnancy
	Pre-conception Genetic Testing
	Pre-conception Clinical Evaluation and Risk Assessment
	Management during Pregnancy
	Delivery
	Summary
	References
Chapter 14: Cardio-Obstetric Considerations in Advanced Heart Failure, Mechanical Circulatory Support, and Heart Transplantation
	Introduction
	Pre-conception Counseling in Patients with Pre-existing Cardiomyopathy
		Risk Assessment
		Contraception
		Termination
	Pregnancy in Pre-existing Cardiomyopathies
		Medical Therapy for Heart Failure
	Mechanical Circulatory Support During Pregnancy
		Percutaneous Ventricular Assist Devices
		Extracorporeal Membrane Oxygenation
		Durable Mechanical Circulatory Support
	Pregnancy after Heart Transplantation
		Patient Selection
		Management of Immunosuppression during Pregnancy
		Monitoring during Pregnancy
		Obstetrical Management
		Maternal and Fetal Outcomes
	Conclusions
	References
Chapter 15: Acute Coronary Syndrome in Pregnancy
	Epidemiology and Etiology
	Pathophysiology
	Clinical Presentation
	Diagnosis
	Medical Treatment
	Invasive Management
		Coronary Angiography
	PCI Considerations in Pregnancy
	P-SCAD
	Coronary Artery Bypass Grafting (CABG)
	Delivery Planning and Post-Partum Care
	Subsequent Pregnancies
	References
Chapter 16: Cardiovascular Imaging in Pregnancy
	Imaging Considerations in Pregnancy
		Positioning
		Ionizing Radiation Exposure
		Contrast Agents
		Transesophageal Echocardiography Procedural Considerations
	Echocardiography in Pregnancy
	Normative Echocardiographic Changes in Pregnancy
	Tissue Doppler Imaging
		Speckle Tracking Echocardiography and Strain
	Computed Tomography (CT)
	MRI
		Stress Testing
	Cardiopulmonary Exercise Testing (CPET)
		Cardiovascular Imaging in Pathologic States in Pregnancy
			Hypertensive Disorders of Pregnancy (HDP)
			Valvular Disorders
			Congenital Heart Disease
			Peripartum Cardiomyopathy
			Aortopathies
			Coronary Heart Disease
			Women Who Have Received Cardiotoxic Cancer Treatments
	Conclusion
	References
Chapter 17: Native Valvular Heart Disease in Pregnancy
	Introduction
		General Recommendations for Counseling and Risk Assessment
	Mitral Stenosis
		Preconception Considerations
		Management
	Mitral Regurgitation
		Preconception Considerations
		Management During Pregnancy
	Aortic Stenosis
		Preconception Considerations
		Management During Pregnancy
	Aortic Regurgitation
		Pre-conception Considerations
		Management During Pregnancy
	Right-Sided Obstructive Lesions
		Management During Pregnancy
	Right-Sided Regurgitation
		Management During Pregnancy
	Conclusion
	References
Chapter 18: Prosthetic Valves
	Introduction
	Bioprosthetic Heart Valves
	Mechanical Heart Valves
	Percutaneous Valves
	Anticoagulation in Pregnancy
	Considering Risks of Prosthetic Heart Valves Throughout Pregnancy Phases of Care
	References
Chapter 19: Simple Congenital Heart Disease in Pregnancy
	Introduction
	Individual Lesions
		PFO/ASD/PAPVR
			Anatomy
			Physiology During Pregnancy
			Potential Complications During Pregnancy
			Monitoring and Care Recommendations
		Ventricular Septal Defect
			Anatomy
			Physiology During Pregnancy
			Potential Complications During Pregnancy
			Monitoring and Care Recommendations
		Patent Ductus Arteriosus
			Anatomy
			Physiology During Pregnancy
			Potential Complications During Pregnancy
			Monitoring and Care Recommendations
		Pulmonary Valvular Stenosis
			Anatomy
			Physiology During Pregnancy
			Potential Complications During Pregnancy
			Monitoring and Care Recommendations
	Conclusions
	References
Chapter 20: Moderate and Complex Congenital Heart Disease in Pregnancy
	Introduction
	Coarctation of the Aorta
		Anatomy
		Genetics
		Physiology
		Potential Complications During Pregnancy
		Specific Recommendations for Pregnancy Management
	Ebstein’s Anomaly
		Anatomy
		Genetics
		Physiology
		Potential Complications During Pregnancy
		Specific Recommendations for Pregnancy Management
	Tetralogy of FALLOT
		Anatomy
		Genetics
		Physiology
		Potential Complications During Pregnancy
		Specific Recommendations for Pregnancy Management
	Transpositions of the Great Arteries
		D-Loop Transposition of the Great Arteries
			Anatomy
			Genetics
			Physiology
			Potential Complications During Pregnancy
			Specific Recommendations for Pregnancy Management
		L-Loop Transposition of the Great Arteries
			Anatomy
			Genetics
			Physiology
			Potential Complications During Pregnancy
			Specific Recommendations for Management During Pregnancy
	Fontan Palliation
		Anatomy
		Genetics
		Physiology
		Potential Complications during Pregnancy
		Specific Recommendations During Pregnancy
	Eisenmenger Syndrome
		Anatomy
		Genetics
		Physiology
		Potential Complications During Pregnancy
		Specific Recommendations for Pregnancy Management
	Conclusion
	References
Chapter 21: Aortopathies and Vascular Complications
	Introduction
	Pre-pregnancy Counseling and Management
		Pre-conception Counseling
		Infertility Treatment
		Genetic Counseling
	Pregnancy Management
	Post-Partum Management
	Management of Aortic Dissection in Pregnancy
	Disease-Specific Considerations
		Aortic Coarctation
		Bicuspid Aortic Valve
		Marfan Syndrome
		Loeys-Dietz Syndrome
		Vascular Ehlers-Danlos Syndrome
		Turner’s Syndrome
		Takayasu Arteritis
	Conclusion
	References
Chapter 22: Overview of Pulmonary Arterial Hypertension in Pregnancy
	Introduction
	Definition
	Etiology
	Physiological Changes in Pregnancy and PAH
	Pregnancy Mortality Risk and Adverse Outcomes
	Preconception Counseling
	Contraception
	Pregnancy Counseling and Termination
	Conclusion
	References
Chapter 23: Pregnancy Management in Patients with Pulmonary Arterial Hypertension
	The Right Ventricle and Pulmonary Vascular Physiology in Pregnancy
	Maternal and Fetal Outcomes
	Pre-conception and Reproductive Counselling
	Management of Pulmonary Hypertension in Pregnancy
		Diagnosis, Monitoring, and Risk Assessment
		Pulmonary Hypertension- Specific Therapy
		Labor and Delivery
		Postpartum Care and Follow-Up
	Conclusion
	References
Chapter 24: Maternal Shock
	Shock Definition
	Maternal ICU Admission and Maternal Shock
	Management of Maternal Shock
		Location and Levels of Maternal Care
	Perimortem Cesarean Section and Cardiac Arrest
	Conclusion
	References
Chapter 25: Arrhythmias in Pregnancy
	Introduction
	Mechanisms and Risk Factors Leading to the Development of Arrhythmias in Pregnancy
	Incidence and Prevalence of Arrhythmias in Pregnancy
		Premature Ectopic Complexes
		Bradyarrhythmia
		SVT
		AF/AFL
		Ventricular Arrhythmias
	Screening for Arrhythmias in Pregnancy
		12-Lead Electrocardiogram (ECG)
		Continuous Ambulatory ECG Monitoring
		Additional Cardiac Testing
		Non-cardiac Evaluation
	Management of Arrhythmias in Pregnancy
		Bradyarrhythmia
		SVT
		PACs
		AF/AFL
		VT
		ICD
		Electrophysiology Studies and Catheter Ablation
	Conclusion
	References
Index