Which of the following are acquired cardiac diseases in the context of pregnancy?

• A. Valvular disorders
• B. Ischemic heart disease
• C. Peripartum cardiomyopathy
• D. All of the above

Answer: (D)

In pregnancy, several cardiac conditions are considered acquired rather than congenital, because they develop or are unmasked due to pregnancy-related changes. Valvular disorders are often acquired because rheumatic heart disease or degenerative processes can affect the valves over time and become clinically apparent during pregnancy when the heart is under increased workload. Ischemic heart disease can occur as the heart faces higher blood volume and cardiac output with protective coronary blood flow sometimes insufficient for the increased demand, especially in those with risk factors. Peripartum cardiomyopathy is a clearly acquired condition that emerges in the last month of pregnancy or in the early postpartum period, presenting as heart failure with reduced ejection fraction in the absence of another identifiable cause. Putting these together, all of the listed conditions can be acquired in the context of pregnancy.