Current Cardiovascular Therapy Series Editor: Juan Carlos Kaski Karen Sliwa John Anthony Editors Cardiac Drugs in Pregnancy Current Cardiovascular Therapy Series Editor Juan Carlos Kaski Karen Sliwa (cid:129) John Anthony Editors Cardiac Drugs in Pregnancy Editors Karen Sliwa John Anthony Department of Medicine, Department of Obstetrics Faculty of Health Sciences and Gynaecology Hatter Institute for Groote Schuur Hospital Cardiovascular Research Cape Town in Africa South Africa Cape Town Western Cape South Africa ISBN 978-1-4471-5471-6 ISBN 978-1-4471-5472-3 (eBook) DOI 10.1007/978-1-4471-5472-3 Springer London Heidelberg New York Dordrecht Library of Congress Control Number: 2013954833 © Springer-Verlag London 2014 This work is subject to copyright. 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Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Pref ace The spectrum of cardiovascular disease affecting women in pregnancy and postpartum is changing and differs between countries. In the western world, the risk of cardiovascular disease in pregnancy has increased due to the increasing age at the first pregnancy and the worldwide obesity epidemic leading also to early diabetes and hypertension. In addition, the treatment of congenital heart disease has improved lead- ing to an increased number of women with residual heart disease reaching childbearing age. In the western world maternal heart disease is now the major cause of maternal death during pregnancy. In the developing world rheumatic heart disease and the cardiomyopathies dominate. Those women often need anticoagulation as they might have had a valve replacement or formed a thrombus in the left heart. Drugs during pregnancy and the breastfeeding period is a complex subject and there is a profound shortage of evidence based recommendations. As drug treatment in pregnancy concern the mother and the fetus, optimum treatment of both must be targeted. This book aims at discussing the most important indica- tions of drug usage in pregnancy and postpartum with the aim of weighing the potential risk of a drug and the possible benefit against each other. Cape Town, South Africa Karen Sliwa Cape Town, South Africa John Anthony v Series Preface Cardiovascular pharmacotherapy is of fundamental impor- tance for the successful management of patients with cardio- vascular diseases. Appropriate therapeutic decisions require a proper understanding of the disease and a thorough knowl- edge of the pharmacological agents available for clinical use. The issue is complicated by the existence of large numbers of agents with subtle differences in their mode of action and efficacy and the existence of national and international guidelines, which sometimes fail to deliver a clear-cut mes- sage. Aggressive marketing techniques from pharma indus- try; financial issues at local, regional, or national levels; and time constraints make it difficult for the practitioner to – at times – be absolutely certain as to whether drug selection is absolutely appropriate. The International Society of Cardiovascular Pharmacotherapy (ISCP) aims at supporting evidence-based, rational pharmacotherapy worldwide. This book series represents one of its vital educational tools. The books in this series aim at contributing independent, bal- anced, and sound information to help the busy practitioner to identify the appropriate pharmacological tools and to deliver rational therapies. Topics in the series include all major car- diovascular scenarios, and the books are edited and authored by experts in their fields. The books are intended for a wide range of healthcare professionals and particularly for younger consultants and physicians in training. All aspects of pharma- cotherapy are tackled in the series in a concise and practical fashion. The books in this series provide a unique set of guidelines and examples that will prove valuable for patient management. They clearly articulate many of the dilemmas vii viii Series Preface clinicians face when working to deliver sound therapies to their patients. The series will most certainly be a useful refer- ence for those seeking to deliver evidence-based, practical, and successful cardiovascular pharmacotherapy. Juan Carlos Kaski, DSc, DM (Hons), MD, FRCP, FESC, FACC, FAHA, ISCP Current Cardiovascular Therapy Series Contents General Principles and Guidelines. . . . . . . . . . . . . . . . . . 1 John Anthony Management of Hypertension. . . . . . . . . . . . . . . . . . . . . . 11 Eckhart J. Buchmann Managing Heart Failure Pre- and Postpartum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Karen Sliwa and Kemilembe B. Tibazarwa Management of Coronary Artery Disease and Arrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Annemien E. van den Bosch, Titia P.E. Ruys, and Jolien W. Roos-Hesselink Anticoagulation in Pregnancy. . . . . . . . . . . . . . . . . . . . . . 79 Vera Regitz-Zagrosek, Christa Gohlke-Baerwolf, Bernard Iung, and Petronella G. Pieper Obstetric Drugs in the Management of Cardiovascular Disease . . . . . . . . . . . . . . . . . . . . . . . . . 107 Catherine Elliott Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 ix