INTRODUCTION Pregnancy is associated with substantial hemodynamic changes, including 30 to 50 percent increases in both cardiac output and blood

volume. In women with a history of heart failure (HF) or other cardiovascular disorders, these demands can lead to clinical decompensation. In addition, women without a history of cardiovascular disease can develop HF due to diseases acquired during pregnancy, such as peripartum cardiomyopathy. (See "Maternal cardiovascular and hemodynamic adaptations to pregnancy" and "Peripartum cardiomyopathy".) HF is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. It is characterized by specific symptoms, such as dyspnea and fatigue, and signs, such as fluid retention. (See "Evaluation of the patient with suspected heart failure".) Because of the concerns related to potential adverse effects on the fetus and the mother, medication use during pregnancy is a challenge. This is an important issue in women with both chronic and acute HF. For example, angiotensin converting enzyme inhibitors and angiotensin receptor blockers, which are part of the standard long-term therapeutic regimen in nonpregnant patients with HF due to systolic dysfunction, are contraindicated in pregnancy. (See "Angiotensin converting enzyme inhibitors and receptor blockers in pregnancy".) The evaluation and management of HF during pregnancy will be reviewed here. The general approach to pregnancy in women with known congenital or acquired heart disease, and overviews of the management of acute and chronic HF are presented separately. (See "Acquired heart disease and pregnancy" and "Pregnancy in women with congenital heart disease: General principles" and "Treatment of acute decompensated heart failure: General considerations" and "Overview of the therapy of heart failure due to systolic dysfunction".) CHRONIC VERSUS ACUTE CONDITIONS For women who are pregnant or considering pregnancy, issues related to heart failure (HF) management can be important in two settings: Subscribers log in here To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:

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