Severe cardiac disease in pregnancy, part I: hemodynamic changes and complaints during pregnancy, and general management of cardiac disease in pregnancy

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Abstract
Part I of this review gives an overview of the hemodynamic changes that occur in normal pregnancy, the approach to the pregnant patient with complaints during pregnancy, and the general management of cardiac disease in pregnancy. The maternal circulatory adaptation to pregnancy consists almost entirely of adaptive changes in the maternal cardiovascular system in response to a primary systemic vasodilatation. Conversely, hemodynamic maladaptation consists of a combination of absence of these changes with signs of sympathetic dominance in the autonomic control of the cardiovascular system. The hemodynamic changes of normal pregnancy per se have profound effects on preexisting cardiac function. Counseling of and care for this subset of patients are challenging for the obstetrician, cardiologist, anesthesiologist and, sometimes, the intensivist to optimize maternal and neonatal survival.

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