Acquired Heart Disease
Acute coronary syndromes and myocardial infarction are rare in pregnancy (1–2 per 35,000 deliveries) but can occur in all stages.3 The usual coronary risk factors apply, and additional risk factors include advanced maternal age, thrombocytosis, blood transfusion, and preeclampsia. Cardiac catheterization is permissible
in pregnant patients, with appropriate abdominal lead coverage for the mother and fluoroscopy time minimized. Thrombolytic agents can be given, but the guidelines for percutaneous coronary intervention should be followed. Direct-current cardioversion is also safe in pregnancy. Supraventricular and ventricular tachycardia should be treated by both nonpharmacologic and pharmacologic means, as in the nonpregnant patient. However, amiodarone should be avoided, because it crosses the placenta and can have toxic effects on the fetus.
The indications for a permanent pacemaker follow the standard guidelines. The need to implant a cardiac defibrillator should be weighed against the need to delay this procedure until after delivery.