SUDDEN CHEST PAIN AND CARDIAC EMERGENCIES IN THE OBSTETRIC PATIENT

Heart disease complicates 0.4% to 4% of pregnancies with the ratio of rheumatic to congenital heart disease having fallen over the past 30 y ears from 20:1 to 3:1. Cardiovascular diseases of major concern in pre gnancy are those with fixed cardiac output (mitral stenosis, Eisenmeng er syndrome, primary pulmonary hypertension), myocardial dysfunction ( dilated cardiomyopathy), risk of aortic rupture (Marfan syndrome, coar ctation of the aorta), and risk of thrombosis (mechanical prosthetic v alve). Pregnant women with heart disease are usually managed in consul tation with a cardiologist. The obstetrician who attends these patient s does not need to know all of the hemodynamic nuances of each cardiac lesion, but should be able to manage life-threatening emergencies unt il the cardiologist arrives.