What should be the approach to a pregnant woman with dilated cardiomyopathy?
(Dr. Sandhya Kamat, Mumbai) Pregnancy is poorly tolerated in women with dilated cardiomyopathy. The risk of maternal death is approximately 7% if the patient is in New York Heart Association (NYHA) functional class III or IV. Other adverse risks factors include ejection fraction <20%, mitral regurgitation, right ventricular failure, Atrial fibrillation (AF) and systemic hypotension. Such patients should be counseled against pregnancy as apart from the risk of maternal death, there is a high risk of overt heart failure occurring during pregnancy, irreversible deterioration in ventricular function and fetal loss. Distinguishing the symptoms and signs of a normal pregnancy from those of heart failure requires careful clinical assessment. Heart failure should be managed as in the non–pregnant patient, but ACE inhibitors are associated with renal agenesis and should be avoided until after delivery. Asymptomatic patients with hypertrophic cardiomyopathy (HCM) usually tolerate pregnancy well
