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Cardiac Critical Care of the Cardio-Obstetric Patient
Amrin Kharawala1, Sanjana Nagraj2,3, Gayatri Setia4,5
1University of Nebraska Medical Center, Omaha, NE, USA.
Insights
Cardiovascular disease (CVD) is a growing cause of pregnancy-related deaths. This review covers common cardiac conditions in pregnant women and their management in cardiac intensive care units (CICUs).
Area of Science:
- Obstetrics and Cardiology
- Maternal Health
- Critical Care Medicine
Background:
- Cardiovascular disease (CVD) is the leading cause of pregnancy-related mortality in the US, with incidence rising significantly over 30 years.
- This increase necessitates greater focus on cardiac intensive care unit (CICU) admissions during the peripartum period.
- Common critical conditions include congestive heart failure, myocardial infarction (MI), hypertensive emergencies, arrhythmias, and cardiogenic shock.
Purpose of the Study:
- To review common cardiac pathologies in the obstetric population.
- To outline diagnostic and management strategies for these conditions within the CICU setting.
- To address the knowledge gap in caring for acutely ill pregnant women with cardiac conditions.
Main Methods:
- Comprehensive literature review.
- Analysis of contemporary management strategies for peripartum cardiac emergencies.
- Focus on diagnosis and treatment in the cardiac intensive care unit.
Main Results:
- Identified key cardiovascular conditions affecting pregnant women, including heart failure, MI, and arrhythmias.
- Highlighted the lack of standardized guidelines for managing these critical conditions.
- Emphasized the importance of specialized care in CICUs for peripartum cardiac emergencies.
Conclusions:
- There is a critical need for standardized guidelines for managing cardiovascular diseases in pregnant women.
- Cardiac intensive care units play a vital role in addressing the rising incidence of peripartum cardiac emergencies.
- This review provides a foundation for understanding and managing these complex cases.
Abstract:
Cardiovascular disease (CVD) is the leading cause of pregnancy-related mortality in the United States, with an incidence that has increased from 7.2 to 32.9 fatalities per 100,000 live births in the last 3 decades. This trend underscores the potential for an increase in the volume of admissions to cardiac intensive care units (CICUs) in the peripartum period. While congestive heart failure remains at the forefront of maternal morbidity, other life-threatening conditions include myocardial infarction (MI), hypertensive emergencies, fatal arrhythmias such as ventricular fibrillation, venous thromboembolism, aortopathies, valvular dysfunction, cardiac arrest, and cardiogenic shock. The lack of standardized guidelines to facilitate management of these conditions highlights the significant gap in medical knowledge while caring for acutely ill pregnant women. Through this comprehensive review, we highlight the most common cardiac pathologies encountered in the obstetric population and their diagnosis and contemporary management in the cardiac intensive care unit.
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