Increase Increase increase Increase

in cardiac output by 40% in stroke volume by 10% in heart rate by 10% or 15 bpm in blood volume by 40% in the peripheral resistance and

Decrease

diastolic blood pressure

 Rheumatic
Cardio

heart diseases

myopathy

 Congenital

heart diseases

ASD, VSD and PDA

Eisenmenger's Syndrome
Tetralogy of Fallot Coarctation of Aorta Marfan's Syndrome Primary Pulmonary Hypertension

Symptoms
Breathlessness palpitations Syncopal

or dyspnoea

attacks oedema heart failure

Pulmonary Congestive

 Eisenmenger's
Primary

syndrome

pulmonary hypertension

Uncorrected Marfan's Severe

severe coarctation

with aortic involvement

mitral stenosis with

complications

 Echocardiography
ECG

 Class

Uncompromised or no limitation of physical

activity
Class

II

Slight limitation of physical activity:

Dyspnoea on severe exertion

Class

III

Marked limitation of physical activity:

Dyspnoea on mild exertion

Class

IV

Severely compromised: Dyspnoea at rest

Preconceptional Counselling
Management

Antepartum NYHA NYHA

CIass l and ll
Class III and IV

 Position.
Fluid

management.

Monitoring Second Third

stage

stage.

 Puerperium
Contraception

 Congestive
Acute

cardiac failure

pulmonary oedema

Arrhythmias. Subacute

bacterial endocarditis