Cardiovascular systemSevere cardiac disease in pregnancy, part I: hemodynamic changes and complaints during pregnancy, and general management of cardiac disease in pregnancyvan Mook, Walther N.K.Aa; Peeters, LouisbAuthor Information aDepartment of Intensive Care and Internal Medicine and bDepartment of Gynecology and Obstetrics, University Hospital Maastricht, Maastricht, Netherlands Correspondence to Walther N.K.A. van Mook, Department of Intensive Care and Internal Medicine, P Debeyelaan 25, 6202 AZ Maastricht, The Netherlands Tel: +31 43 3876385; fax: +31 43 3874330; e-mail: firstname.lastname@example.org Current Opinion in Critical Care: October 2005 - Volume 11 - Issue 5 - p 430-434 doi: 10.1097/01.ccx.0000179807.15328.f0 Buy Metrics Abstract Purpose of review Part I of this review gives an overview of the hemodynamic changes that occur in normal pregnancy, the approach to the pregnant patient with complaints during pregnancy, and the general management of cardiac disease in pregnancy. Recent findings The maternal circulatory adaptation to pregnancy consists almost entirely of adaptive changes in the maternal cardiovascular system in response to a primary systemic vasodilatation. Conversely, hemodynamic maladaptation consists of a combination of absence of these changes with signs of sympathetic dominance in the autonomic control of the cardiovascular system. Summary The hemodynamic changes of normal pregnancy per se have profound effects on preexisting cardiac function. Counseling of and care for this subset of patients are challenging for the obstetrician, cardiologist, anesthesiologist and, sometimes, the intensivist to optimize maternal and neonatal survival. © 2005 Lippincott Williams & Wilkins, Inc.