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1 !!"!# $ %&'"( )( & (!'*+&-"' )$ %&./' (+ 0!" # &"'"#... 2 (... 3 #... 4 #... 4 )... 5 * # +-*./ '"# #... 5 "1" # " &... 8 %##... 8 (%# $%#% % ##$ $ % #%... 13!% ##%##$ 5 "' $ # Side 1

2 + 1+2-" (! + /)! 1+ / 1! 1&-"(!$3!'/ 4 +!+ o % 5 / o %!// 262/ o %!+/ o 0 / 4 +! +!2(+!&7898'+ ++/ 1 # # " % $ # # ###6 ##'$ '! ) ###" " # 61" $ # 1# 6#"$ % "# & $ # "#" #+ 7/" $%# %## % ##$ Side 2

3 + # $" # 6" # #.% # '$% 6 "% " 8 # 9 ":; " <#+"/61# $%#6 "# " # # " +-*.8=- *./# ' # -*.5 ' 1 5 +%5#5 "6&/' "5 0 $ %'#1 $'# %#"%' 6 % ###<"$5% # ' '# "# 1$ $ 8 $+%>!/ '%5 ##6 '16# ' 6#? 5?" # #8# '" $ #$ # $ #" % # "' #" # # +' "%"# # "$#1/6 # +"'#/6 # 6#"$ $%#"%# # $#% ##+ #%/6 # #% $ ##'?? #" 1'#6 6# #%6 #%# & # '1@ # 6##" : 0" 1 " '5 : > "6#1 % ##6" " " # # " # Side 3

4 ' "1 " " 6" $#' " ''< $ % "6# " " "' $ 6# 1" #'"$ # #$ # # # 1$ # " # 6# " 6# $ -*. # "<"% # " 1+/$ 2. # $ #"$'"# )-.4# '51"6#$ $ $ " & # #1# % # # #" # +" # # $/ #'"$ #$%6 2. # $ % ###### "#$ $ "$ + ##" ##' # ##" >'# & : 3# A# B &%# #'"'# " #$ 6' # 5$ #6# "$'" 6 ' " $ A #" '' " $ #'"# #%# "$'" $+ "@#$ Side 4

5 # %##/ 3" #" #'"$%#"%+$ %/"$'"%## ' $ $ "## #$$ " $ 6 $ " ' # # # "$#1$ "6$ $ % $ : + &/;:"' - +;(! 1 - +;(! $; 3!; # 2 1$ " # # " $ " # # " 6$ #$ # #"% # 6## ##### " $ $ "% " $ " $55# 6 $ "% " "6#$% # #?? '6 #'2.6$ 1# Side 5

6 ### ## 6&#1*"* % 1%"* % +*/ B *$ 1" " # $ 6# "1" ;C9 2%*")1 %1%+2*)/$ "; B " 1"# 1'# $<0!+;/"2.D$1 : " # ## " << + /4 + 22! 2!!+ / $2+! "(!/ ) -" Niels Vejlstrup overlæge kardiologisk afdeling: niels.vejlstrup@gmail.com Lars Søndergaard overlæge kardiologisk afdeling: lars.sondergaard@rh.dk Heidi Sharif overlæge obsterisk klinik: heidi.fosgrau.sharif@rh.hosp.dk Lene Grønbech afdelingslæge obstetrisk Klinik: l.groenbeck@dadlnet.dk Vibeke Hornbak overlæge thoraxanæstesi: vibeke.hornbak@rh.regionh.dk Vagthavende R1 kardiologisk afdeling: Vagthavende R1 obstetrisk afdeling: Vagthavende R1 obstetrisk anæstesi: Vagthavende R1 thorax/intensiv anæstesi: Omstillingen RH: (! Keld Sørensen overlæge kardiologisk afdeling: keldsoer@rm.dk Niels Holmark Andersen afdelingslæge kardiologisk afdeling: holmark@ki.au.dk Olav Bjørn Petersen overlæge obstetrisk afdeling: olavpete@rm.dk Inge Krogh Severinsen Overlæge Thorax anæstesi: ingeseve@rm.dk Vagthavende R1 kardiologisk afdeling: Vagthavende R1 obstetrisk afdeling: Vagthavende R1 obstetrisk anæstesi: Vagthavende R1 thorax/intensiv anæstesi: /8899 Omstillingen Skejby: Side 6

7 - Reference List (1) Lewis G. The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers' Lives: reviewing maternal deaths to make motherhood safer The Seventh Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. Lewis G editor London CEMACH Ref Type: Report (2) Bodker B Hvidman L Weber T Moller M Aarre A Nielsen KM et al. Maternal deaths in Denmark Acta Obstet Gynecol Scand 2009; 88(5): (3) Søndergaard L Johansen M Nørrelund M Palm P Hedegaard M Kolbye A et al. Sammenhængende monitorering og opfølgning af gravide med hjertesygdom København Sundhedsstyrelsen Center for Evaluering og Medicinsk Teknologivurdering Ref Type: Report (4) Warnes CA Williams RG Bashore TM Child JS Connolly HM Dearani JA et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography Heart Rhythm Society International Society for Adult Congenital Heart Disease Society for Cardiovascular Angiography and Interventions and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 52(23):e (5) Bonow RO Carabello BA Chatterjee K de Leon ACJ Faxon DP Freed MD et al focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists Society for Cardiovascular Angiography and Interventions and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 52(13):e (6) Blomstrom-Lundqvist C Scheinman MM Aliot EM Alpert JS Calkins H Camm AJ et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Supraventricular Arrhythmias). Circulation 2003; 108(15): Side 7

8 (7) Baumgartner H Bonhoeffer P De Groot NM de HF Deanfield JE Galie N et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 2010; 31(23): (8) Nelson-Piercy C. Handbook of Obstetric Medicine. Third ed. London: Informa Healthcare; ) E "1 ) *E531%. ")1< 1 F > ##%% & # ' %#6# #6 6 #% "% ##'# ' #### '# 6 $ 1 # $ # %# 0 $ - "' '" ''" $ " ' # 4 / 1 ; ) <' # ( ' 0 "!'# # ' -# "1 A# ( #" %##15 #6 %.'#% ##$ 6%6 > > 2"$ ) 6 3*) )6 + 0>>>6!$ ' " 6 Side 8

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16 6# " *<( # '1##6# #%# ' "## $# ' % ##6#'<"% #$5% #66 #$# '# " #+11+ /6 6 + // 0% #. " ' "#'"' # ' 1 " $"6 1<"6 + 1 #/+" %1 / ## "$7 ## #'# "*01 #'$% "# # "6# ###" ' 1 " < "#'# %## + 6 #/ < #% +/$ ' " # # %+ #%6#' # >1 6###:5@"# '$ 6 #+/ '$66" " %6%5 ## '%## ( $ ' 6#$ ###% '# '#+% 6 %6%%#60" / 0$7 % $% + #/ "# " Side 16

17 *01 $ % ##' A' '% " $ #$ #+6.#/ " 3# 6"# " # #%%%# E $ %#% ## $ $" ' # " &%#' " %"## # ' ' '# %# 1#'$ 6##"## 6 '%%#$%6# %%#' % "% + "%' /6"'#6$%716"6 $ +# #%/##% # # " ' # %%#?"? " ' % '$ " #+./ ( % ;# " 6"# $# # 1 $%$%? ( % % "%?? " 5%#%"% 8"$'"%####.# % 1!'%%#' #! "#% ' #1$%' %#% ' # # 1#5# +"%/ Side 17

18 #% 1$ # " "$#1 " 3# $"#% ( ' ####" # % " #% " '"#%##" "' ' 1 Henvisning 1 Akut kardiologisk tilsyn Ovenstående gravide kvinde i G P i uge har i 3. trimester udviklet ( ) Svær åndenød ( ) Tegn på lungestase ( ) Ventrikulære arytmier Der ønskes jvf. retningslinjer for visitering af gravide med hjertesygdom foretaget ekkokardiografi inden for 24 timer. Henvisning 2 Akut kardiologisk tilsyn Ovenstående gravide kvinde G P i uge har ( ) Uforklarede svære brystsmerter ( ) Lungeemboli er udelukket ( ) Iskæmiske forandringer i EKG Der er følgende disponerende faktorer Der ønskes akut kardiologisk vurdering for at udelukke aortadissektion eller ustabil iskæmisk hjertesygdom Henvsining 3 Kardiologisk tilsyn Side 18

19 Ovestående gravide kvinde G P i uge BT. Puls har ( ) Brystsmerter ved fysisk aktivitet/psykisk påvirkning ( ) Svær dyspnø ved fysisk aktivitet ( ) Iskæmi i EKG ( ) Normale koronarmarkører Der ønske kardiologisk vurdering mhp. evt. iskæmisk hjertesygdom. Henvisning 4 Kardiologisk vurdering på Center for gravide med hjertesygdom Ovenstående gravide kvinde G P i uge har BT. Puls har hjertebanken. ( ) Der er EKG under anfald som viser: ( ) Vurdering af kardiolog: Henvisning 5 Kardiologisk vurdering på Center for gravide med hjertesygdom Ovenstående gravide kvinde G P i uge har BT. Puls SAT er kendt med følgende hjertersygdom: Tidligere operationer: Hvor er pt tidligere behandlet og fulgt for sin hjertesygdom: Symptomer: Medicin: Der vedlægges EKG og relevante journalnotater. Side 19

20 + Side 20