Cardio-Obstetrics Fundamentals for Fellows-Heart Failure in Pregnancy

Video Transcription

Video Summary

Module 3 addresses the evaluation and management of heart failure in pregnancy, emphasizing early recognition due to its critical impact on maternal and fetal outcomes. Heart failure can emerge from pre-existing cardiac conditions or newly during pregnancy, often confused with normal pregnancy symptoms like dyspnea and edema. Key presenters discuss diagnostic strategies, including the use of cardiac biomarkers (NT-proBNP, troponin) and echocardiography, highlighting abnormal signs such as elevated jugular venous pressure and crackles that warrant further cardiovascular assessment.<br /><br />The module presents clinical cases illustrating diverse presentations, such as congestive heart failure with preserved ejection fraction and pre-existing dilated cardiomyopathy worsening during pregnancy. Management involves risk stratification, close monitoring, safe medication use (beta blockers, diuretics, hydralazine/nitrates), and multidisciplinary care teams including cardiologists, obstetricians, and anesthesiologists. High-risk patients require frequent assessments and may need invasive hemodynamic monitoring.<br /><br />Peripartum cardiomyopathy, a key focus, is defined as systolic dysfunction arising late pregnancy or postpartum, diagnosed by exclusion, and marked by varying recovery trajectories. Therapy aligns with heart failure guidelines, adjusted for pregnancy and breastfeeding safety, with anticoagulation considerations due to increased thrombotic risk. Emerging treatments such as bromocriptine are under study.<br /><br />Acute heart failure and cardiogenic shock during pregnancy require rapid identification and management using hemodynamic data and pharmacologic or mechanical support (inotropes, ECMO). Delivery planning balances maternal cardiac status and fetal maturity, favoring vaginal delivery when possible with tailored anesthesia and tertiary care resources.<br /><br />Overall, the module underscores the importance of distinguishing heart failure from normal pregnancy changes, employing comprehensive diagnostics, multidisciplinary management, individualized therapeutic strategies, and anticipatory planning to optimize maternal and neonatal outcomes.

Keywords

heart failure in pregnancy

maternal cardiac evaluation

fetal outcomes

cardiac biomarkers

echocardiography

peripartum cardiomyopathy

multidisciplinary care

hemodynamic monitoring

pregnancy-safe medications

delivery planning