Chapter 9: Cardiac disease

Cardiac disease: Specific recommendations

As recommended in other Chapters of this Report, pregnant immigrant women require a complete medical examination, including cardiovascular examination, by an appropriately trained doctor at booking.

Maternity health care professionals must remember the possibility of rheumatic heart disease in immigrant women and there should be a low threshold for investigation if any symptoms develop.

Women at higher risk of developing cardiac disease in pregnancy, i.e. the obese, those who smoke or who have existing hypertension and/or diabetes, a family history of heart disease and those over the age of 35, should be appropriately counselled of these risks pre-conception and particularly prior to receiving assisted reproductive technology (ART) or other infertility treatment.

Clinicians should have a low threshold for further investigating pregnant or recently delivered women, especially those with any of the above risk factors, with severe chest pain, chest pain that radiates to the neck, jaw or back, chest pain associated with other features such as agitation, vomiting or breathlessness, tachycardia, tachypnoea or orthopnea. Appropriate investigations include an electro-cardiogram (ECG), a chest x-ray (CXR), cardiac enzymes (Troponin), echocardiogram and CT pulmonary angiography.

If a clinician is not confident or competent to interpret an ECG, he/she should discuss the woman’s case and show her ECG to someone who is.