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 following recommendations: (1) weekly or biweekly medical consultation; (2) body weight control; (3) insisting on avoiding activities that require great effort; (4) moderate salt intake restriction; (5) eventual removal from professional activities that require great effort; (6) maintaining non-teratogenic medications and (7) hospitalizing patients who continue in NYHA FC III with optimized medication. 349 Obstetric evaluation concomitant to cardiologic care is important to establishment of gestational age. In this manner, fetal viability and growth conditions and the placental flow situation are factors that support therapy and reflect the maternal hemodynamic condition. Pharmacological treatment of HF with reduced ejection fraction (HFrEF) differs from treatment for the general population of women with heart disease regarding the class of drugs used, daily dose, and therapeutic goals, 52 given that teratogenic drugs should be substituted during preconception. Beta-blockers, especially beta-1-cardioselective ones (metoprolol, bisoprolol, and carvedilol), are considered first-line drugs, because they are beneficial with respect to mortality due to HF and CSD, and they improve symptoms and reduce rates of re‑hospitalization due to HF. 345 For these reasons, the use of these beta-blockers should be maintained during gestation in cases with HFrEF. Figure 11 – Algorithm for diagnosis of heart failure. BNP: natriuretic peptide; HFpEF: heart failure with preserved ejection fraction; HFrEF: heart failure with reduced ejection fraction. Adapted from Rohde et al., 2018. 345 Anamnesis Personal and family history Gestational age of symptoms Physical examination Identify factors of decompensation of HF Anemia, Infection and Arrhythmias ECG if available Low Yes No Normal Heart failure not probable Physiological of pregnancy Implement treatment Heart failure probable HFpEF/HFrEF Alteread High Natriuretic Peptide Echocardiogram Structural evaluation, LVEF and diastolic function BNP > 100 pg/mL Table 38 – Signs and symptoms of pregnancy Signs/symptoms Normal pregnancy Complicated pregnancy Dizziness, palpitation Common Exercise syncope Dyspnea Common (75%), mild, and non-progressive Progressive or NYHA FC IV Orthopnea Common, especially at the end of gestation – Decreased exercise tolerance Mild and non-progressive NYHA FC IV Chest pain Common, non-progressive, generally skeletal-muscular Typical angina or important chest pain during gestation or in the postpartum period Pulse Increased volume or frequency Decreased or ascending volume Peripheral edema Common, mild Important or progressive Apical heart sound Hyperdynamic, slightly lateralized Third sound with splitting Heart rate Common, sinus tachycardia AF, persistent SVT, symptomatic ventricular arrhythmias Neck veins Slightly distended Progressively distended with dominant ‘v’ wave AF: Atrial Fibrillation; FC: Functional Class; NYHA: New York Heart Association; SVT: Supraventricular Tachycardia. 912