Pregnancy in women with hypertrophic cardiomyopathy

Abstract

Hypertrophic cardiomyopathy (HCM) is increasingly being diagnosed in pregnant women. Women with HCM generally tolerate pregnancy well. The risk is however higher in women who are symptomatic before pregnancy or in those with severe left ventricular outflow tract obstruction. The incidence of arrhythmias does not appear to be increased during pregnancy and maternal mortality is low. Prior to conception, women with HCM should have a risk assessment as well as genetic counselling. During pregnancy beta-blockers should be continued and the judicious use of diuretics may be required to treat symptoms of dyspnoea. A vaginal delivery with regional anaesthesia is usually appropriate. Women should be managed by a specialist multidisciplinary team.

Fig. 1

Hypertrophic cardiomyopathy is primarily diagnosed by echocardiography. Apical 4-chamber view, systolic frame, showing hypertrophied, echogenic interventricular septum (S), systolic anterior motion of the anterior mitral valve leaflet (arrow), dilated left atrium (LA), left ventricle (LV)