The journal, published since , is the official publication of the Spanish Society of Cardiology and founder of the REC Publications journal family. Articles are published in both English an Spanish in its electronic edition. The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years. CiteScore measures average citations received per document published. SRJ is a prestige metric based on the idea that not all citations are the same.
Understanding and Managing Pregnancy in Patients with Lupus. Although the word "undifferentiated" sounds vague, it describes a real problem. Diagnosis approach pulmonary hypertension during pregnancy I. Studies comparing TNF-inhibitor levels in maternal blood to fetal cord blood at time of delivery have shown variability across different anti-TNF agents [ ]. Lupus and Collagen vascular disease pregnancy antiphospholipid syndrome in pregnancy and obstetrics: clinical characteristics, diagnosis, pathogenesis, and treatment. Another study found that anti-RNP antibodies were significantly correlated with Raynaud's phenomenon and arthritis. Whereas fluorinated glucocorticoids e. Guidelines Collzgen prevention, diagnosis and treatment of infective endocarditis.
Latinas fair skin. Explore the PC Journal
Kelley Collagen vascular disease pregnancy Firestein's Textbook of Rheumatology. However, having a lowered immunity can also increase your risk of becoming sick. First case series on the use of calcipotriol- betamethasone dipropionate for morphea. Physical therapy or gentle exercise can be used to treat collagen vascular disease. Persistent telangiectasia may be managed with vascular laser. Since this condition is rare in children organ specific therapeutic protocol, as for adults, is not available. Occurrence of herpes zoster was noted in some patients. Autologous stem cell transplantation ASCT has been tried in adolescents with SLE achieving prolonged disease remission, without any drug therapy. Treatment of recalcitrant generalized morphea Crazy party teens infliximab. Plasmapheresis Plasmapheresis was the conventional therapy for life-threatening JDM prior to the Collagen vascular disease pregnancy use of immunosuppressive drugs. Silverman E. The complex, multisystemic nature of these disorders requires a multidisciplinary approach.
Cardiovascular disease CVD , which includes diseases of the heart, brain blood supply, and vascular system, is the number one cause of death in the United States.
- Of the various collagen vascular diseases seen in pediatric age group, discoid lupus erythematosus, systemic lupus erythematosus, neonatal lupus erythematosus, juvenile dermatomyositis and childhood scleroderma are common and of practical importance to clinicians.
- Collagen vascular disease is a terminology used for group of disorders that pertains to problems related with connective tissue in the body.
- A connective tissue disease collagenosis is any disease that has the connective tissues of the body as a target of pathology.
Cardiovascular disease CVD , which includes diseases of the heart, brain blood supply, and vascular system, is the number one cause of death in the United States. Despite improvements in treatment, CVD remains the leading cause of mortality in women. See By the numbers. For example, women with diabetes and those who smoke are at higher risk than men who have diabetes or smoke.
No clear answer exists. Women of color are at greater risk for CVD than white women. Black women in the United States are at higher risk for an MI than all other women, and many experience an MI at a younger age. Because they may have no symptoms, they have higher rates of sudden cardiac death. For example, women may have prodromal symptoms for up to a year prior to a cardiac event. See Prodromal symptoms. See MI symptoms.
In some cases, they delay going to the ED up to 2 hours longer than men; women of color delay going to the hospital longer than white women. The updated AHA guidelines for the prevention of heart disease in women identify three risk levels: ideal cardiovascular health, at risk, and high risk.
See Know the risk. Let your patients know that the ideal diet consists primarily of whole grains, vegetables, fruits, and protein sources low in saturated fats, such as lean meats and tofu. According to the U. The AHA guidelines recommend minutes per week of moderate exercise or 75 minutes per week of vigorous exercise. Examples of vigorous-intensity exercise include running, fast cycling, fast swimming, and heavy shoveling or digging. Two days per week of muscle-strengthening activities that involve all major muscle groups offer additional cardiovascular benefit.
Recommend that your patients go to bed and get up at the same time every day; remove electronic devices from the bedroom; avoid alcohol, caffeine, and large meals before bedtime; and get regular exercise.
Reducing stress can be challenging for many women. Suggest that patients try meditation, yoga, listening to music, and walking. For success, stress-reduction plans should be individualized; for example, walking a dog might relieve stress in one person but be stress-inducing in another. Cigarette smoking is contraindicated for a heart-healthy lifestyle.
If your patient smokes, help her develop a cessation plan. Start by establishing her readiness to quit. The latter site has tools such as text messages including ones specific for pregnant women , mobile apps, and a craving journal. The guidelines recommend including a thiazide diuretic medication unless contraindicated. If women are at high risk, treatment also should include a beta-blocker, an ACE inhibitor, or an angiotensin II receptor blocker.
Avoid aspirin therapy in women younger than 65 years old with ideal cardiovascular health because of bleeding risk; however, it should be considered in high-risk women and in those over 65 years old when their blood pressure is controlled and the benefit of stroke and MI prevention outweighs the risk of bleeding.
The AHA guidelines also recommend treating women who have atrial fibrillation with aspirin, warfarin, or dabigatran. Many cardiovascular health disparities exist related to race, ethnicity, and gender, particularly among Black and Hispanic women. Develop individualized care plans, offering patients options for maintaining their health. For example, logging food intake and daily exercise may work best for some patients, while others may prefer using smartphone apps to encourage adherence to treatment plans and medication regimens.
Research is needed to determine the effectiveness of these apps. For those who are interested in support groups, provide resources and information. When that happens, explore possible reasons, such as lack of access to primary care providers, time constraints, and resistance to lifestyle modifications. Be nonjudgmental when exploring these reasons, and collaborate with the patient to revise the treatment plan.
Education is the cornerstone to reducing CVD risk and death among women. Remind your female patients of the MI symptoms unique to women, and explain that they should seek immediate medical care if they experience any of them. To ensure early identification and treatment of women at risk for a cardiovascular event, all healthcare professionals should adhere to the AHA guidelines for all female patients regardless of race or ethnicity and provide culturally sensitive care. Empower at-risk women to make wise lifestyle choices, and support and encourage adherence to prescribed treatment plans.
American Heart Association. Heart and stroke statistics. Sex, ethnicity, and CVD among women of African descent: An approach for the new era of genomic research.
Glob Heart. J Cardiovasc Nurs. Am J Cardiol. Mayo Clinic. Heart disease in women: Understand symptoms and risk factors. Acute myocardial infarction in women: A scientific statement from the American Heart Association. Effectiveness-based guidelines for the prevention of cardiovascular disease in women— update: A guideline from the American Heart Association. Office of Disease Prevention and Health Promotion. Physical activity guidelines for Americans. Wenger NK. J Womens Health.
Thank you so much for the information about how I need to have minutes of exercise per week to maintain good heart health. Unfortunately, there was no mention of the use of dual anti-platelet medications to manage acute coronary syndrome following stent placement.
The AHA guidelines 1 focus on the use of dual anti-platelet agents aspirin plus P2Y12 inhibitor therapy and emphasize the importance of appropriate pharmacologic agents with long-term follow up. The data are based on landmark trials that demonstrated statistically significant reduction in the occurrence of recurrence of culprit or non-culprit lesions.
In the case, follow up medications with anti-hypertensives, statins, and ASA was stressed, but the use of dual anti-platelet therapy with a P2Y12 inhibitor was omitted.
Nursing can have a major role in reminding patients to continue the use of long-term medication management to offer sustained risk reduction, and the authors missed a great opportunity in the case review to make that special point. Save my name, email, and website in this browser for the next time I comment.
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Collagen vascular disease pregnancy. What Causes Collagen Vascular Disease?
Pregnancy and autoimmune connective tissue diseases
The journal, published since , is the official publication of the Spanish Society of Cardiology and founder of the REC Publications journal family. Articles are published in both English an Spanish in its electronic edition. The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years.
CiteScore measures average citations received per document published. SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.
SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. The number of pregnant women with coronary disease is expected to grow due to advanced pregnancy-maternal age, the development of reproductive techniques, and increased cardiovascular risk factors in women. Even though rheumatic fever has decreased in developed countries in recent years, 4 it continues to be a serious problem in developing countries.
Immigrants form a risk group, especially those who, for social reasons, are unaware of the inherent risks of heart disease during pregnancy or are even unaware of the existence of heart disease..
The main physiological changes during pregnancy are increased blood volume, heart rate and cardiac output, and decreased peripheral vascular resistance. At the beginning of pregnancy, this increase is due to stroke volume, whereas, as pregnancy progresses, increased heart rate is the main factor Figure.
Due to this hyperdynamic situation, nearly all pregnant women present a soft midsystolic murmur during auscultation. Given the increase in mammary blood flow, a continuous murmur may be heard. Even though diastolic murmurs can be physiological during pregnancy, heart disease should be ruled out if there are any..
This increase in CO is not constant, since this fluctuates according to position: the compression of the inferior vena cava by the gravid uterus in the supine decubitus position decreases venous return, thus decreasing CO.. In addition, ventricular diameters increase slightly, although remaining within normal limits. Left ventricular contractility is depressed slightly and ejection fraction is maintained, given the preload and afterload conditions. This reduction in afterload is due to the fact that the placenta is a high-flow, low-resistance circuit.
Pulmonary pressures remain normal during pregnancy; a decrease probably occurs in pulmonary vascular resistance that compensates for the increase in blood flow..
Very important hemodynamic changes occur during delivery due to pain, anxiety, and uterine contractions. The magnitude of this increase rises as delivery progresses..
In general, family planning, discussing contraceptive methods and how future pregnancies will affect the mother and fetus should begin during adolescence.
The information should include estimations of maternal mortality and morbidity during pregnancy, as well as the risk of heart failure, arrhythmias or long-term ventricular dysfunction. Parental life expectancy or the need for heart surgery should be discussed, since these are issues that obviously affect a couple's ability to care for their child.
Thus, if pregnancy is suitably planned, both fetal and maternal risk can be estimated and minimized. Regarding the timing of pregnancy, for example, pregnancy is tolerated better in those with systemic right ventricle or univentricular heart if the patient is in her 20s rather than if she is older than Percutaneous intervention or mitral valve replacement surgery before pregnancy should also be considered in patients with hemodynamically significant mitral valve disease.
Nevertheless, the use of tissue valves should be considered regarding any surgical intervention.. Generally, the following aspects should be considered:. In the largest prospective multicenter study, done in Canada in pregnant women with heart disease CARPREG , the frequency and predictors of cardiovascular complications were examined during pregnancy.
Three deaths were recorded. A prospective observational study of 90 pregnancies in 53 women has recently been published in relation to the patient population with congenital heart disease.
The event rate during pregnancy was The risk of transmission of congenital heart disease to the children should be considered before conception. In these cases, the possibility exists of carrying out a chorionic biopsy for prenatal diagnosis at the 12th week of pregnancy.. In the absence of risk factors, the incidence of neonatal complications was similar to that of women without heart disease..
This risk is especially high if there is a maternal condition that involves limiting the increase in cardiac output, so restricting placental flow, and this worsens if it is concomitant with other obstetric risk factors.. Biometry of the fetus is warranted in women with risk factors, as well as in patients with hypertension during pregnancy or those treated with beta-blocker see box referring to drugs and hypertension.. The level of care and monitoring during pregnancy should be determined before pregnancy or as soon as this is confirmed.
In general, it is essential that prenatal care and delivery are carefully planned. Some patients will benefit from hospitalization during the third quarter, with rest, monitoring and O 2 therapy for example, in cyanotic patients. In view of the fact that many general obstetricians will only see a few patients with heart disease, it is important to refer them to a specialized center, since pregnant women with high-risk heart disease should be frequently assessed, including echocardiographic study.
Table 4 shows the principal heart diseases classified into low, moderate, and high risk. Each entity is specifically discussed below.. For all these reasons, the benefits and maternal and fetal risks should be carefully assessed before administering a given drug during pregnancy. These are treated similarly but conservatively, when possible, meaning that antiarrhythmic agents should be administered, as well as any drug during pregnancy, at the lowest effective dose and with the shortest duration possible.
Paroxysmal supraventricular tachycardia PSVT can be treated via vagal maneuvers; if there no response the use of intravenous adenosine may be effective. Beta-blockers are the drugs of choice for prophylaxis of supraventricular or ventricular arrhythmias during pregnancy. Fetal heart rate should be controlled and the maternal airway protected in particular. Amiodarone should only be used as a second-line drug in case of resistance to other antiarrhythmic agents..
The fact of carrying an implantable cardioverter-defibrillator ICD does not by itself counterindicate pregnancy. In a series of 44 pregnancies in women carrying an ICD, a greater incidence of discharges was not observed during pregnancy nor were there special maternal or fetal complications. Finally, if strictly necessary, a pacemaker should be implanted during pregnancy.
The effects of radiation can be minimized via sonography.. A recent document on the management of cardiocirculatory arrest during pregnancy outlines the following differential aspects 27 :. In these patients, it is essential to always consider the possibility of magnesium sulfate excess, eclampsia with multiorgan failure, acute myocardial infarction, aortic dissection, massive pulmonary embolism, amniotic fluid embolism, trauma, and drug overdose..
The risk of thromboembolism during pregnancy undergoes a 5-fold increase, during puerperium this risk increases fold and is greater after cesarean section. This should be taken it into account in women whose heart disease involves a risk of thrombosis.. Low-molecular-weight heparin LMWH is safe for treating deep vein thrombosis, but the dose should be initially adjusted via factor Xa-activated blood clotting time.. Prosthetic thrombosis during pregnancy has been described even with state-of-the-art prostheses in the aortic position.
Finally, patients carrying a mechanical prosthesis are at particularly high risk during pregnancy, and the risks and benefits of using oral anticoagulants compared to heparin should be carefully considered..
Infectious endocarditis is uncommon during pregnancy but can be difficult to manage. The need for surgical treatment should be weighed against the risk of fetal loss, but should not be delayed if the pregnant woman is in a life-threatening situation..
The American Heart Association and the European Society of Cardiology 29,30 do not recommend the use of prophylactic antibiotics during delivery; despite this, many centers carry it out. Although the beneficial effect of such prophylaxis has not been demonstrated, their use seems reasonable in particularly high-risk women, such as those with previous episodes of bacterial endocarditis, those carrying a valvular prosthesis or pregnant women with heart disease considered as being at high risk of endocarditis undergoing operative vaginal delivery..
Any pregnancy is accompanied by certain symptoms, such as fatigue, decreased capacity for exercise and dyspnea. Thus, deterioration in functional class by itself is not an indication for hospitalization, given its subjectivity; the increase in jugular venous pulse and the presence of peripheral edema could lead to an erroneous diagnosis of heart failure.. Pharmacological treatment will include beta-blockers, digitalis and oral diuretics.
Cases of severe heart failure require hospitalization and the use of intravenous diuretics, in addition to vasodilators to reduce afterload. In life-threatening cases, the temporary use of intraaortic balloon counterpulsation, or left ventricular assistance can be indicated.
Although maternal mortality is similar to that outside of pregnancy, such surgery should be reserved for patients resistant to medical treatment where the delay in surgical treatment could have serious consequences. The complexity of the intervention and the duration of the bypass directly affect fetus viability, which means that, if gestational age allows for this, a cesarean section should be done after heparinization and cannulation. If the gestational age does not permit extrauterine viability, the fetus and uterine activity should be monitored during surgery.
Whenever possible, normothermic bypass should be done and sudden changes in maternal blood flow avoided. Delivery should be planned carefully. Intrapartum management should be supervised by a team with expertise in the care of pregnant women with heart disease obstetricians, anesthesiologists and nurses and a cardiologist should be available. Maternal monitoring during delivery may require electrocardiographic monitoring, pulse oxymetry and, occasionally, invasive blood pressure assessment.
The main aim is to manage the effort and stress arising from delivery in such a way that the woman does not exceed her capacity to cope.. In principle, delivery should not be induced except for obstetric reasons. Spontaneous delivery is usually faster and involves fewer complications. Specifically, vaginal delivery carries half the risk of complications of an elective cesarean section for both the mother and fetus, since it involves smaller fluctuations in blood volume lower hemorrhage rates.
However, prolonged deliveries should be avoided. Epidural analgesia is fundamental; drugs that cause fewer cardiovascular alterations are used to avoid abrupt hemodynamic changes. Oxytocic drugs, such as ergometrine and oxytocin, have cardiovascular effects.
Continuous oxytocin perfusion, at the lowest effective dose, has minimal cardiovascular effects.. Continuous monitoring during the postpartum period is necessary in high-risk patients if necessary, in the coronary unit , particularly in women with pulmonary hypertension or cyanosis, who have a risk of maternal mortality in the first 10 postpartum days..
The effect of increased cardiac output on a right ventricle with previous volume overload in patients with atrial septal defect ASD is counterbalanced by the decrease in peripheral vascular resistance; thus, pregnancy is well-tolerated in these types of conditions, with few complications.
Paradoxical embolism is rare in patients with ASD. Pregnancy is also well-tolerated by patients with restrictive ventricular septal defect VSD and small patent ductus arteriosus..
Thus, all patients with symptomatic AS should postpone pregnancy until after heart surgery. Even in asymptomatic women with moderate AS, pregnancy can cause heart failure..
The absence of an increase in gradient during pregnancy can indicate ventricular dysfunction. The main complications reported are associated with severe hypertension, including aortic dissection. Changes in the aortic wall during pregnancy increase the risk inherent to CoA..
Maternal death occurred in one patient with Turner syndrome type A dissection. Although pregnancy is considered low-risk in women with previously repaired CoA, the risk of dissection is small but not eliminated, especially if there is a residual aneurysm at the repair site. Mild or moderate pulmonary stenosis PS is well-tolerated during pregnancy, with good maternal and fetal prognosis. However, in patients with severe PS, pregnancy can cause severe heart failure or arrhythmias..