Practice points
Any woman who develops severe chest pain during pregnancy or early in the post-partum
period should be investigated to exclude aortic dissection, pulmonary embolism or
myocardial infarction.
Any woman who develops symptoms that could be due to cardiac ischaemia should have
this excluded with serial ECG and troponin assessment.
All women with heart disease who are considering pregnancy should be referred for
specialist expert joint cardiac and obstetric pre-pregnancy counselling and assessment.
Women with severe ventricular impairment, residual ventricular impairment following previous
peripartum cardiomyopathy, severe left-heart obstruction, Marfan syndrome with
aortic dilatation >45 mm or pulmonary arterial hypertension should be advised that pregnancy
is associated with a significant risk of mortality.
Women with mechanical prosthetic heart valves should have expert counselling about the
management of anticoagulation in pregnancy, and they should have meticulous monitoring
during pregnancy.