Division of Cardiology, New York Presbyterian-Columbia University Irving Medical Center (E.M.D., J.H.H.).
St Vincent Heart Center, Indianapolis, Indiana (M.N.W.).
Circ Heart Fail. 2021 May;14(5):e008223. doi: 10.1161/CIRCHEARTFAILURE.120.008223. Epub 2021 May 13.
Heart failure (HF) is a leading cause of morbidity and mortality in pregnant women in the United States. Although peripartum cardiomyopathy is the most common diagnosis for pregnant women with HF, women with preexisting cardiomyopathies and systolic dysfunction are also at risk as the hemodynamic demands of pregnancy can lead to decompensation, arrhythmia, and rarely death. The differential diagnosis of HF in pregnancy is broad and includes Takotsubo or stress cardiomyopathy, exacerbation of a preexisting cardiomyopathy, such as familial cardiomyopathy, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, or left ventricular noncompaction. This review will explore the implications of pregnancy in women with preexisting cardiomyopathies and de novo HF, risk assessment and preconception planning, decisions about contraception, the safety of HF medications and implantable cardioverter-defibrillators during pregnancy, pregnancy in women with left ventricular assist devices and following heart transplantation.
心力衰竭（HF）是美国孕妇发病率和死亡率的主要原因。虽然围产期心肌病是 HF 孕妇最常见的诊断，但患有先前存在的心肌病和收缩功能障碍的女性也有风险，因为妊娠的血液动力学需求可能导致失代偿、心律失常，极少数情况下还会导致死亡。HF 在妊娠中的鉴别诊断范围很广，包括 Takotsubo 心肌病或应激性心肌病、先前存在的心肌病恶化，如家族性心肌病、肥厚型心肌病、致心律失常性右室心肌病或左室致密化不全。本综述将探讨妊娠对先前存在的心肌病和新发 HF 女性的影响、风险评估和孕前规划、避孕决策、HF 药物和植入式心脏复律除颤器在妊娠期间的安全性、左心室辅助装置和心脏移植后妊娠。
