ABC | Volume 114, Nº5, May 2020

Statement Brazilian Cardiology Society Statement for Management of Pregnancy and Family Planning in Women with Heart Disease – 2020 Arq Bras Cardiol. 2020; 114(5):849-942 Table 31 – Practice for chronic ventricular tachycardia Recommendation Beta-blockers in pregnant women with long QT syndrome and catecholaminergic polymorphic VT during gestation and the postpartum period, including those who are breastfeeding ICD implantation should be performed before gestation; in the event that this is indicated during gestation, it should be performed using minimal radiation (guided by echocardiogram, for example) and, preferably, after the first trimester Beta-blockers or verapamil for preventing episodes of idiopathic sustained VT Sotalol or flecainide for preventing episodes of idiopathic sustained VT, if other substances are not effective Catheter ablation, with the use of electroanatomical mapping systems, for sustained VT that are not well tolerated or refractory to treatment with antiarrhythmic drugs ICD: implantable cardioverter-defibrillator; VT: ventricular tachycardia. • Thromboembolism with lower transitory risk factor, such as travel time (class IIC). Investigation of thrombophilia is not recommended in the following situations: • Prior thromboembolism without an apparent cause (class IB) and thromboembolism related to hormone use or during a previous gestation (class IIC) require indication of tromboprophylaxis; • Personal history of the disease with a major transitory risk factor (fracture, surgery, prolonged immobility) (class IIB); • Obstetric history of recurring fetal loss, placenta praevia, IUGR, and preeclampsia. 5.2.4. Diagnosis Final diagnosis may be compromised by signs and symptoms which are inherent to normal pregnancy, such as edema, pain in lower limbs, chest pain, precordial palpitation, and dyspnea. Nevertheless, clinical evaluation is the essential basis for seeking conclusive diagnosis, because there is still not a single screening test that is sufficiently sensitive to define the situation. Furthermore, most studies that evaluate diagnostic imaging examinations for thromboembolism and flowcharts for diagnosis exclude pregnant women due to a concern for maternal-fetal safety. 5.2.4.1. Deep Vein Thrombosis Diagnosis based on clinical picture (anamnesis and clinical examination) is concerning, because it determines whether or not the patients will require permanent anticoagulant therapy during gestation. This situation requires subsidiary examinations in order to conclude diagnosis, which should be expedited, given that sudden death is not uncommon in pregnant women with signs and symptoms compatible with this disease. Structured risk scores for classifying pregnant women as low-, intermediate-, or high-risk for DVT, such as the Wells’ score, have not been validated for use during gestation. The LEFT rule on the other hand has been proposed for specific prediction of the chance of DVT during pregnancy, and it appears to be promising. If none of its variables Table 32 – Risk factors for venous thromboembolism during gestation Preexisting factors Transitory factors Obstetric factors 1. Prior thromboembolism 1. Gestation Prenatal: 2. Thrombophilias 2. Hyperemesis gravidarum 1. Assisted reproduction 3. Family history of thromboembolism 3. Dehydration 2. Multiple pregnancy 4. Comorbidities: SLE, nephrotic syndrome, drepanocytosis, cancer, paraplegia 4. Ovarian hyperstimulation syndrome 3. Preeclampsia 5. Diabetes mellitus 5. Infection Delivery: 6. Inflammatory diseases (especially intestinal) 7. Immobility 1. Prolonged labor 7. Over 35 years of age 8. More than 4 hours of travel Surgical: 8. Obesity 2. Cesarean delivery, Postpartum sterilization 9. Tobacco use 3. Stillbirth 10. Lower limb varicose veins 4. Forceps 11. Parity ≥ 3 Postpartum: 12. History of stillbirth 1. Postpartum hemorrhage 13. Pre-term delivery 2. Blood transfusion SLE: systemic lupus erythematosus. 906