• Pregnancy with Prior Ischemic Heart Disease he advisability of pregnancy after a myocardial infarction is unclear. Ischemic heart disease is characteristically progressive, and because it is usually associated with hypertension or diabetes, pregnancy in most of these women seems inadvisable. In a review of 30 pregnancies in women who had sustained an inarction remoterompregnancy, none of the women died, four had congestive heart failure, and four had worsening angina during pregnancy (Vinatier, 1994). Pombar and coworkers (1995) evaluated outcomes of women with diabetes-associated ischemic heart disease and infarction. Three had undergone coronary artery bypass grafting before pregnancy. Of 17 women, eight died during pregnancy. Certainly, pregnancy raises cardiac workload, and these investigators concluded that ventricular performance should be assessed using ventriculography, radionuclide studies, echocardiography, or coronary angiography before conception. Without signiicant ventricular dysfunction, pregnancy will likely be tolerated. For the woman who becomes pregnant before these studies are performed, echocardiography is done. Exercise tolerance testing may be indicated, and radionuclide ventriculography exposes the fetus to minimal radiation.
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