Pregnancy and heart disease: what Internists should know

Pregnant women with heart disease are increasing due to medical and surgical progress and, nowadays, congenital heart disease is the most frequent heart disease affecting these women. Pregnancy represents a considerable effort for an altered heart with negative consequences for life quality, disease progression and mortality. Risk differs a lot among patients and depends not only on the type of heart disease. Clinician should stratify risk and offer patients a correct pre-counselling and accurate follow- up. At the same time Clinician should be able to diagnose rapidly heart failure as some cardiopathies, such as peripartum cardiomyopathy, are related to pregnancy and produce symptoms that can be confused with normal pregnancy progression. This brief review gives the opportunity to Internists to revise the most important aspects of management according to the recent literature. After having analyzed the pathophysiological mechanism of pregnancy, risk stratification and the salient elements of counselling, this review depicts the most important features of different heart diseases during pregnancy, giving warnings to Clinician about the fragile aspects to consider. Finally, it offers suggestions on therapy. General recommendations do not change during pregnancy, but some drugs are prohibited and dosage can sometimes be greater.