ABSTRACT
Background: Total 0.2% to 4% of all pregnancies are complicated by cardiac diseases. In non western countries, rheumatic heart diseases (RHD) constitute 56-89% of the cases and congenital heart diseases only 9-19%. Aim and objectives: To review all obstetric patients with co-existing cardiac diseases admitted to a tertiary care center over a period of one year and ascertain the causes of admissions and the maternal and perinatal morbidity and mortality. Material and methods: A retrospective, analytical study of all patients with cardiac diseases who delivered over a period of January 2013 to December 2013 was conducted. A tabulated representation of the data was done. The various cardiac diseases were categorized according to their severity, NYHA category, type of pathology, the maternal and perinatal outcome was assessed and maternal mortality and perinatal mortality was recorded. Conclusion: Total 69% cardiac lesions in pregnancy were rheumatic in origin and 15% belonged to high risk category while 13.1% were NYHA type IV. Total 69% deliveries were by vaginal route Epidural analgesia preferred in LSCS of cardiac patients. Perinatal and maternal complications were observed to increase with increase in NYHA class.
ABSTRACT
Introduction: Warfarin causes arterial calcification, arterial stiffness and systolic hypertension in animals. Early evidence in humans indicates that a similar effect may occur in patients with diabetes mellitus (DM) and/or hypertension. Objective: To evaluate whether warfarin use causes elevated blood pressure and pulse pressure in patients with both DM and hypertension. Methods: Cross-sectional study of 159 subjects with both DM and hypertension who received warfarin for at least 2 years and 159 age-matched control subjects with DM and hypertension never exposed to warfarin. The primary focus of analysis was the difference in systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP) between the two groups. Results: Average age was 73±10 years in both groups. Patients in the warfarin group had received it for an average of 5.5±3.1 years. Subjects in the warfarin group had higher rates of coronary disease and heart failure. SBP and PP were lower in the warfarin group (SBP 130±14 mmHg vs. 134±12 mmHg, P=0.003; PP 58±12 mmHg vs. 62±11 mmHg, P=0.004), while DBP was not different (72±8 vs. 72±7 mmHg, P=0.64). Warfarin patients received more antihypertensive drugsand were seen more often than controls. Multiple regression analyses adjusting for relevant variables did not disclose an association between warfarin useand higher BP; on the contrary, exposure to warfarin was associated with lower SBP and PP on the multivariable models. Conclusion: Use of warfarin in conventional doses for an average of 5.5 years was not associated with increased BP in this cross-sectional study of patients with DM and hypertension.
Introdução: Em animais, a warfarina provoca calcificação arterial, rigidez arterial e hipertensão arterial (HA) sistólica. Dados preliminares em humanos sugerem que o mesmo efeito pode acontecer em pacientes com diabetes mellitus (DM) e/ou HA. Objetivo: Determinar se o uso da warfarina em pacientescom DM e HA resulta em elevação da pressão arterial ou pressão de pulso. Métodos: Estudo transversal de 159 pacientes com DM e HA que haviam sidotratados com warfarina por pelo menos 2 anos, e 159 controles pareados por idade, com DM e HA, mas que nunca haviam usado warfarina. O enfoqueprincipal na análise foi a diferença na pressão arterial sistólica (PAS), diastólica (PAD) e pressão de pulso (PP) entre os dois grupos. Resultados: A média de idade foi 73±10 anos em ambos os grupos. Os pacientes no grupo da warfarina haviam usado a droga por 5.5±3.1 anos. Pacientes no grupo da warfarina tinham uma prevalência maior de doença coronariana e insuficiência cardíaca. A PAS e PP foram mais baixas no grupo warfarina (PAS 130±14 mmHgvs. 134±12 mmHg, P=0.003; PP 58±12 mmHg vs. 62±11 mmHg, P=0.004), mas a PAD não diferiu entre os grupos (72±8 vs. 72±7 mmHg, P=0.64).Pacientes do grupo warfarina usaram mais drogas antihipertensivas e foram avaliados clinicamente com maior freqüência do que os controles. Regressão múltipla ajustada para fatores de relevância clínica não demonstrou nenhuma associação entre o uso da warfarina e elevação da pressão arterial. Pelo contrário, nos modelos de regressão múltipla, a exposição à warfarina associou-se a valores mais baixos de PAS e PP. Conclusão: O uso da warfarina em doses convencionais, por 5.5 anos, não associou-se a um aumento da pressão arterial neste estudo tranversal de pacientes com DM e hipertensão.